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Introduction: This study reevaluates the historical origins of occlusion therapy for amblyopia, focusing on the contributions of the 9th-century Islamic scholar, Ali ibn Sahl ibn Rabban al-Tabari (838–870 CE). Methods: The investigation delved into al-Tabari's writings, particularly "Firdous al-Hikma," to extract insights into his approach to addressing reduced vision in one eye.Additionally, the study examined subsequent advancements in occlusion therapy by scholars such as Thabit ibn Qurrah and Rhazes, building upon al-Tabari'sfoundational work. Results: Al-Tabari's reports contain significant insights into occlusion therapy for amblyopia, predating commonly attributed origins of the treatment. Within "Firdous al-Hikma," he outlines methods for addressing reduced vision, advocating for the covering of the healthier eye to promote the function of the weaker eye. These findings highlight the pioneering efforts of al-Tabari and his contemporaries in the Islamic civilization and challenge the conventional narrative surrounding the history of occlusion therapy. Subsequent advancements by scholars such as Thabit ibn Qurrah and Rhazes expanded upon al-Tabari's work, advocating for similar therapeutic approaches within the Islamic civilization. Their contributions further solidified the practice of occlusion therapy, laying the groundwork for its continued evolution and refinement in subsequent centuries. Discussion: Al-Tabari's contributions to occlusion therapy underscore the rich heritage of scientific inquiry in theIslamic civilization during the medieval period. This historical perspective sheds light on the diverse contributions to medical knowledge and practice outside of Western contexts and emphasizes the importance of recognizing and honoring these contributions in the broader history of medicine. [ABSTRACT FROM AUTHOR]

Background: The utilization of complementary and alternative medicine (CAM) is experiencing a global surge, accompanied by the adoption of national CAM policies in numerous countries. Traditional Persian medicine (TPM) is highly used as CAM in Iran, and the ongoing scientific evaluation of its interventions and the implementation of evidence-based medicine (EBM) encounters various barriers. Therefore, comprehending the characteristics and interactions of stakeholders is pivotal in advancing EBM within TPM policies. In this study, we utilized both classical stakeholder analysis and social network analysis to identify key stakeholders and potential communication patterns, thereby promoting EBM in TPM policy-making. Methods: A cross-sectional nationwide stakeholder analysis was conducted in 2023 using snowball sampling. The interviews were carried out using a customized version of the six building blocks of health. Data were collected through semi-structured interviews. Stakeholders were assessed based on five factors (power, interest, influence, position, and competency). The connections and structure of the network were analyzed using degree, betweenness, closeness centrality, and modularity index to detect clusters of smaller networks. Results: Among twenty-three identified stakeholders, the Ministry of Health and Medical Education (MOHME) and the Public were the most powerful and influential. The Iranian Academy of Medical Sciences was the most competent stakeholder. Social network analysis revealed a low density of connections among stakeholders. Pharmaceutical companies were identified as key connectors in the network, while the Public, supreme governmental bodies, and guilds acted as gatekeepers or brokers. The MOHME and Maraji were found to be high-ranking stakeholders based on four different centrality measures. Conclusion: This study identifies powerful stakeholders in the network and emphasizes the need to engage uninterested yet significant stakeholders. Recommendations include improving competence through education, strengthening international relations, and fostering stronger relationships. Engaging key connectors and gatekeepers is essential for bridging gaps in the network. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is one of the most prevalent eye diseases. This study aimed to evaluate the efficacy and safety of Latilactobacillus sakei (L. sakei) either as an ophthalmic bacterial lysate (drops, no live organism) or as an oral probiotic (capsules) on immunological and clinical outcomes of patients with DED. This study was a randomized, placebo-controlled, triple-masking clinical trial with four parallel arms. Patients were randomly assigned in a 2x2 factorial design combining active vs placebo capsules and active vs placebo eye drops in a 1:1x1:1 ratio. The ophthalmic drops are approved for use in the European Union as a medical device (CE registration code 0425-MED-004235). A total of 40 patients were evaluated. DED signs and symptoms decreased significantly by using active drops compared to placebo, as measured by the Ocular Surface Disease Index (OSDI), Tear Break-up Time (TBUT), and Schirmer I tests (all p<0.0001). Conversely, neither active capsules nor their interaction effect with active drops achieved significance vs placebo. There was also a significant decrease in the tear levels of IL-6 (p=0.0007), TNFα (p<0.0001), and IFNγ (p<0.0001) in patients receiving active drops. Intake of both active products (drops and capsules) was well tolerated. Postbiotic ophthalmic formulation containing L. sakei lysate significantly improved the signs and symptoms of DED and suppressed ocular surface inflammatory response. Conversely, oral intake of L.sakei as a probiotic capsule had no effect in these patients (ClinicalTrials.gov: NCT04938908). [ABSTRACT FROM AUTHOR]

Aim: To conduct a comparative analysis of risk factors for retinopathy of prematurity (ROP) in single- and multiple-born neonates. Methods: In a retrospective evaluation of 521 premature neonates, encompassing singletons, twins, and triplets born at or before 34 weeks of gestational age with a birthweight of less than 2000 g and who completed the ROP screening program, between 2020 and 2023, in outpatient referral ROP screening clinic affiliated by Shiraz University of Medical Sciences, were included. Neonates with the eligibility criteria were enrolled in the screening program from 28 days old age and followed up to discharge or treatment based on national ROP screening guideline. Data on ROP severity, outcome, treatment modality, and risk factors, including gestational age (GA), birth weight (BW), sex, duration of neonatal intensive care unit (NICU) admission, oxygen supplementation, mechanical ventilation, blood transfusion, method of delivery, and maternal and neonatal comorbidities, were extracted and compared between premature neonates from singleton and multiple births. Results : The analysis of the ROP severity distribution revealed 238 neonates (45.7%) with low-risk (type 2 prethreshold ROP or less severe) ROP and 16 (3.1%) with high-risk (type I prethreshold ROP or more severe) ROP who underwent treatment. According to the comparative analysis of risk factors in neonates with ROP requiring treatment, multiple birth neonates exhibited significantly greater GA (27.50 ± 3.27 vs. 30.00 ± 2.00 vs. 31.14 ± 0.38 weeks, p = 0.032 for singletons, twins and triplets, respectively); greater BW (861.67 ± 274.62 vs. 1233.33 ± 347.75 vs. 1537.14 ± 208.86 g, p = 0.002); and shorter duration of NICU admission (60.17 ± 21.36 vs. 34.00 ± 12.17 vs. 12.00 ± 6.32 days, p = 0.001) and oxygen supplementation (47.33 ± 16.57 vs. 36.00 ± 8.49 vs. 4.60 ± 2.41 days, p = 0.001). There was no significant difference between single-born neonates and multiple-born neonates regarding the prevalence of other risk factors. Multiple-born neonates with no ROP and low risk ROP showed significantly lower GA and BW compared to singletons (p < 0.001). Conclusion: Multiple gestation neonates may develop high-risk ROP requiring treatment at a greater gestational age and birth weight and at a lower duration of oxygen supplementation and NICU admission compared to the single birth neonates. This pattern prompts a reevaluation of screening criteria, suggesting a potential need to consider multiple birth neonates with lower traditional risk factors in screening programs. This pattern should be further evaluated in larger populations of multiple born premature neonates. [ABSTRACT FROM AUTHOR]

Despite the existence of numerous eye drops in the market, most of them are not sufficiently effective because of quick clearance and the barriers within the eye. To increase the delivery of the drugs to the eye, various new formulations have been explored in recent decades. These formulations aim to enhance drug retention and penetration, while enabling sustained drug release over extended periods. One such innovative approach is the utilization of contact lenses, which were originally designed for cosmetic purposes and vision correction. Contact lenses have appeared as a promising formulation for ocular drug delivery, as they can increase the bioavailability of drugs in the eye and diminish unwanted side effects. They are specifically appropriate for treating chronic eye conditions, making them an area of interest for researchers in the field of ophthalmology. This review outlines the promising potential of nanomaterial-laden contact lenses for diagnosis and treatment of glaucoma. It classifies therapeutic approaches based on nanomaterial type, summarizes diagnostic advances, discusses improvement of contact lenses properties, covers marketing perspectives, and acknowledges the challenges of these innovative contact lenses for glaucoma management. [ABSTRACT FROM AUTHOR]

Background and Aim: Tinnitus is a common disorder of the auditory system with a rich history dating back to ancient times. This review aims to provide a historical perspective on tinnitus in Traditional Persian Medicine (TPM) by summarizing the views of TPM scholars on its etiology and treatment. Methods: A qualitative research (summative content analysis) was conducted, utilizing TPM texts to identify the historical perspectives of TPM scholars on tinnitus. The analysis focused on their understanding of tinnitus, its causes, and recommended treatments. Results: In TPM, tinnitus was referred to as Tanin and Davi. The accumulation of phlegm and internal gases in the head or ears was considered as the main cause of tinnitus, with sudden movement or ripple of these vapors leading to auditory nerve stimulation and resulting in tinnitus. TPM scholars recommended addressing the sources of these vapors, such as gastrointestinal issues, and promoting humeral balance through temperament modification and the use of medicinal herbs for treatment. Conclusion: The TPM view on tinnitus was similar to the Greco-Roman understanding of the disease, with Persian scholars expanding on its details. TPM scholars believed in addressing the underlying causes of tinnitus and promoting humeral balance to alleviate symptoms. These historical perspectives provide insight into traditional medical systems and their approaches to the management of health conditions. [ABSTRACT FROM AUTHOR]

There is growing evidence for the involvement of sex hormones in the pathogenesis of keratoconus. This study aimed to evaluate serum androgen and prolactin levels in patients suffering from keratoconus. One hundred and two subjects were enrolled in the keratoconus (76 patients) and control (26 subjects) groups in a cross-sectional survey. Topographic evaluation of the cornea was undertaken for all enrolled participants. Serum testosterone, dehydroepiandrosterone sulphate (DHEAS), prolactin (PRL), luteinising hormone (LH), and follicle-stimulating hormone (FSH) were measured in all subjects. There was no significant difference in demographic characteristics between the study groups. Significantly higher mean serum levels of DHEAS (3.71 ± 2.23 vs. 2.53 ± 1.77 µg/mL; P = 0.009) and T (6.18 ± 3.80 vs. 1.57 ± 1.76 ng/mL; P < 0.001) were observed in men with keratoconus compared to controls. In females, there were also higher mean levels of DHEAS (2.40 ± 1.57 vs. 2.18 ± 0.72 µg/mL; P = 0.355) and T (0.78 ± 0.96 vs. 0.32 ± 0.13 ng/mL; P < 0.001) in patients with keratoconus but only T level reached the statistically significant level of difference. Also, the mean serum PRL level was significantly higher in women with keratoconus compared to control (13.33 ± 17.85 vs. 4.63 ± 3.10 ng/mL; P < 0.001). There was no significant difference between serum FSH and LH levels between study groups. In patients with keratoconus, serum PRL in females and serum androgen levels in both genders are elevated. [ABSTRACT FROM AUTHOR]

Crocin is a natural ingredient of saffron (Crocus sativus L.) flower that has shown potential for application as a supplement in eye health and preserving vision. Crocin has been examined for its potential to treat various eye diseases such as glaucoma, macular dystrophies, diabetic retinopathy, and age-related macular degeneration. This review briefly discusses the role of crocin in different eye diseases. The underlying pathophysiological pathways involved in the effect of crocin on ophthalmic diseases are also reviewed. Preclinical evidence shows the cytoprotective, antioxidative, anti-inflammatory, and blood-flow enhancing effects of crocin in retinal tissue. Crocin also affects the retinal pathologies by activating PI3K/Akt and inhibiting NF-κB signalling pathways. Clinical evidence suggests that crocin improves outcomes in patients with retinal degenerations, retinal dystrophies, and glaucoma. Overall, crocin can be suggested as a potential vision supplement in healthy populations and patients with eye diseases. However, more clinical studies with larger sample sizes and longer follow-up durations are needed to confirm the current evidence. [ABSTRACT FROM AUTHOR]

With the growing access to new types of reference tools, today's L2 writers have a plethora of choices when completing an academic writing assignment. Such resources are absent in most high-stakes academic writing exams, making the two situations dissimilar. Aimed to compare the performances of ESL writers in Exam and Non-exam (real-life) academic writing situations, the present study recruited seven ESL university students who had previously taken an IELTS test. The students completed two analogous writing tasks: an exam-setting and a Non-exam writing test which aimed to simulate the real-life setting. Coh-Metrix analysis of the linguistic features of syntactic complexity, lexical sophistication, and text cohesion of the writings suggested that the students improved the textual quality of their writings in real-life academic writing situation. In addition, FACETS analysis of the quality of the writings, as assessed by the human raters, showed that the students did not benefit equally from the merits of the real-life settings compared to the Exam settings. The findings suggest that the students spent different amounts of time and used different types of queries to consult with external resources. Students' background training and writing strategies can highly affect their performance in real-life academic writing compared to the writing exams, warning against the validity of such tests. [ABSTRACT FROM AUTHOR]

Ptosis surgery induces some changes in pre-existing refractive errors and astigmatism. Monitoring refractive outcomes, planning of vision rehabilitation, and amblyopia treatment may be required following ptosis surgery. The few studies published on the outcomes of refractive error after ptosis surgery have been controversial. The aim of this study was to evaluate long-term outcomes of refractive error in patients with congenital blepharoptosis who had undergone ptosis surgery. Patients with congenital blepharoptosis who had undergone ptosis surgery were enrolled in the study. Data on pre- and post-operative refractive errors, marginal reflex distance 1 (MRD1), and levator function were obtained. The data from fellow eyes were used as the control. The mean patient age of patients undergoing ptosis surgery was 19.8 ± 8 years. The mean follow-up time (time between the operation and post-up measurements) was 4.7 ± 2.1 years with a range of 2–10 years. There were no significant differences in mean refractive changes, being 0.53 ± 0.40D vs. 0.36 ± 0.45D in sphere (p = 0.19) and 0.48 ± 0.56 vs. 0.30 ± 0.23 in cylinder (p = 0.17) in operated and control eyes, respectively. Astigmatism change was, however, significantly higher in the operated eyes with an MRD1 change of ≥2.5 mm (0.84 ± 0.66 vs. 0.27 ± 0.39, p = 0.024). The changes in astigmatism in the operated eyes had a significantly positive correlation with the changes of MRD1 (r = 0.497, p = 0.019). Vectorial analysis showed no significant difference between the changes in astigmatism of the operated and control eyes (0.58 *48º vs. 0.45*53º, respectively). Spherical power of the eyes of patients with congenital ptosis who undergo ptosis surgery does not change. A significant change in astigmatism can be anticipated in eyes with more than 2.5 mm change in MRD1. There is an association between change in astigmatism and MRD1 following ptosis surgery. [ABSTRACT FROM AUTHOR]

Saffron (Crocus sativus L., family Iridaceae) is used traditionally for medicinal purpose in Chinese, Ayurvedic, Persian and Unani medicines. The bioactive constituents such as apocarotenoids, monoterpenoids, flavonoids, phenolic acids and phytosterols are widely investigated in experimental and clinical studies for a wide range of therapeutic effects, especially on the nervous system. Some of the active constituents of saffron have high bioavailability and bioaccessibility and ability to pass the blood-brain barrier. Multiple preclinical and clinical studies have supported neuroprotective, anxiolytic, antidepressant, learning and memory-enhancing effect of saffron and its bioactive constituents (safranal, crocin, and picrocrocin). Thus, this plant and its active compounds could be a beneficial medicinal food ingredient in the formation of drugs targeting nervous system disorders. This review focuses on phytochemistry, bioaccessibility, bioavailability, and bioactivity of phytochemicals in saffron. Furthermore, the therapeutic effect of saffron against different nervous system disorders has also been discussed in detail. [ABSTRACT FROM AUTHOR]

Primary hypothyroidism is a common disease. Some patients have persistent symptoms despite normal serum thyroid-stimulating hormone (TSH) levels. Ginger is reported to be beneficial in relieving similar symptoms. Our aim was to evaluate the efficacy of ginger supplementation in relieving persistent symptoms in these patients. In this randomized, double-blind, placebo-controlled clinical trial, 60 hypothyroid patients aged 20–60 years with normal serum TSH concentrations were randomly allocated to two equal parallel study groups of ginger (500 mg twice a day) or placebo for 30 days. Hypothyroid symptoms were evaluated as the primary outcome using the Thyroid Symptom Rating Questionnaire (ThySRQ) before and after the intervention. Anthropometric measures and laboratory indices including TSH, triglyceride (TG), total cholesterol (TChol), and fasting blood sugar (FBS) were considered as secondary outcomes. A significant lower mean total ThySRQ score (8.63 ± 5.47 vs. 15.76 ± 6.09, P < 0.001) was observed in the ginger group compared to the control group. Ginger led to significant improvements in the mean scores of the weight gain, cold intolerance, constipation, dry skin, appetite, memory loss, concentration disturbance, and feeling giddy or dizzy domains (P < 0.001). However, no significant improvements were observed in hair loss, nail fragility, hearing, hoarseness, speech, and depression or feeling down (P > 0.05). Ginger supplementation also led to a significant decrease in body weight, body mass index, waist circumference, serum TSH, FBS, TG, and TChol levels compared to the placebo. In summary according to preliminary results of this study, ginger supplementation can help relieve persistent hypothyroid symptoms. Also, it may have beneficial effects in terms of weight reduction and regulation of the FBS and lipid profile in hypothyroid patients. [ABSTRACT FROM AUTHOR]

Capparis spinosa, Rosa canina, Securidaca securigera,Silybum marianum, Urtica dioica, Trigonella foenum-graecum and Vaccinium arctostaphylos are used traditionally as an herbal combination for treatment of diabetic patients in Iran. Despite the clinical evidence supporting their use in solitary form, no controlled human study has determined the efficacy and safety of their combination in treatment of diabetic patients. A total 150 type II diabetic patients of both sexes under the oral anti-hyperglycemic drugs treatment (maximum 10 mg glyburide and 1000 mg metformin daily) were randomly assigned to three groups. The patients in each group received either herbal combination or placebo or metformin capsule daily for three months, without any change in their previous oral anti-hyperglycemic drugs dosage. Herbal combination, placebo and metformin capsules matched by shape and color were prepared in the Institute of Medicinal Plants Karaj, Iran. To assess the efficacy and safety of the treatments, the patients fasting plasma glucose, HbA1c, lipid profile, liver enzymes and renal function were determined at the beginning of the study and after three months. Results showed that after three months, the fasting plasma glucose, HbA1c and cholesterol levels in herbal combination were decreased significantly as compared to placebo group (20% and 12% respectively) and also compared to base line (25% and 15% respectively). The herbal combination was as effective as metformin in reduction of FPG (p = 0.001, p = 0.001) and HbA1c (p = 0.028 and p = 0.050 respectively) compared to placebo. No notable hepatic, renal and gastrointestinal side effects were observed in the trial groups. The results suggest that traditional herbal combination may safely improve glycemic control in type II diabetic patients with no significant adverse effect. [ABSTRACT FROM AUTHOR]

Objectives: To review red algae bioactive compounds and their pharmaceutical applications. Content: Seaweed sources are becoming attractive to be used in health and therapeutics. Among these red algae is the largest group containing bioactive compounds utilized in cosmetic, pharmaceutical, food industry, manure and various supplements in food formula. Various significant bioactive compounds such as polysaccharides (aginate, agar, and carrageenan), lipids and polyphenols, steroids, glycosides, flavanoids, tannins, saponins, alkaloids, triterpenoids, antheraquinones and cardiac glycosides have been reported in red algae. The red algae have rich nutritional components Different polysaccharides of red algae possess the antiviral potential namely agarans, carrageenan, alginate, fucan, laminaran and naviculan. Sulfated polysaccharides and carraginans of red algae are rich source of soluble fibers which can account for antitumor activities depending upon chemistry of various secondary metabolites and metabolism of cell line. Flavons-3-ols containing catechins from many red algae block the telomerase activity in colon cancer cells. Contraceptive agents were tested from red algae as a source for post-coital. Lectin of red algae showed pro-healing properties and anti-ulcerogenic activities. Carragenates from red algae also conferred a positive influence on diabetes. Red algae depicted a reducing effect on plasma lipids and obesity. Porphyran from red alga can act as anti-hyperlipidemic agent also reduces the apolipoprotein B100 via suppression of lipid synthesis in human liver. Summary: The polyphenolic extracts of Laurencia undulate, Melanothamnus afaqhusainii and Solieria robusta extract show anti-inflammatory effects against multiple genera of devastating fungi. Antioxidants such as phlorotannins, ascorbic acids, tocopherols, carotenoids from red algae showed toxicity on some cancer cells without side effects. Red algae Laurencia nipponica was found insecticidal against mosquito larvae. Red algae fibers are very important in laxative and purgative activities. Gracilaria tenuistipitat resisted in agricultural lands polluted with cadmium and copper. Outlook: In the recent decades biotechnological applications of red algae has been increased. Polysaccharides derived from red algae are important tool for formulation of drugs delivery system via nanotechnology. [ABSTRACT FROM AUTHOR]

Objective: Acute and chronic ethanol consumption cause oxidative stress and ginger improves suchconditions. In this study, the protective effects of ginger were studied on indices of oxidative stress, total homocysteinelevel and the level of the some of the oxidative stress-associated trace elements against toxicity induced by ethanol in rat eye. Materials and Methods:Twenty-four adult male Sprague-Dawley rats were randomly allocated into four groups and treated daily for 28 days as follows: group I: control;group II: ginger (1g/kg/day ginger extract by oral gavage); group III: ethanol (4g/kg/day ethanol by oral gavage) and group IV: ginger+ethanol. At the end of the experimental period, eye tissue sera were used for determination of different parameters. Furthermore, in vitro antioxidant potential and total phenol content of ginger extract were determined. Results: In ethanol group, significant changes in oxidative stress markers and levels of homocysteine and some trace elements, compared to other groups, were observed (p<0.05 for all cases). However, these parameters significantly ameliorated with pretreatment with ginger in ginger+ethanol group (p<0.05 for all cases), and had no significant differencesinthese parameters betweenginger and control group were found. Conclusion: It can be concluded that ginger extract has protective effects against toxicity induced by ethanol in the eye of male rat. [ABSTRACT FROM AUTHOR]

Chemotherapy‐induced peripheral neuropathy (CIPN) is one of the most common complications in patients with cancer. Citrullus colocynthis (bitter apple) has been used in traditional Persian medicine as an effective pain relief, especially for neuralgia. We designed a pilot clinical trial to evaluate the safety and efficacy of topical C. colocynthis oil in management of CIPN in breast cancer patients. Thirty‐four cancer patients with CIPN were randomly enrolled in two arms of a randomized, double‐blind, placebo‐controlled clinical trial. The patients were treated by topical C. colocynthis oil or placebo, two times per day for 2 months. Functional Assessment of Cancer Therapy/Gynecologic Oncology Group (FACT/GOG)‐Neurotoxicity (Ntx) score was set as the primary outcome measure. No significant improvement was observed in the total score of FACT/GOG‐Ntx scale (2.40 ± 1.90 vs. 1.05 ± 1.36, p = .879) in drug and placebo groups, respectively. There was also no significant improvement in the mean scores of FACT/GOG‐Ntx in the sensory, motor, hearing, and functional domains in the two study groups. According to the results of this preliminary study, topical C. colocynthis oil failed to improve the symptoms of CIPN compared with placebo. [ABSTRACT FROM AUTHOR]

Background: Despite growing demand for medicinal plants, there is little data about their use by patients with dyslipidemia. We aimed to determine the prevalence, pattern, and associated factors for the use of medicinal plants among patients with dyslipidemia. Methods: A 17-item semi-structured questionnaire was filled out by 195 patients with dyslipidemia in a cross-sectional study carried out in two academic endocrinology clinics in Shiraz, Iran. The questionnaire comprised of three main domains of demographic data (6 questions), clinical data (2 of them), and data related to the use of medicinal plants (totally 9 questions). Results: A total of 77.4% of patients took medicinal plants. The most common medicinal herbs used by dyslipidemic patients were Zataria multiflora, Cinnamomum zeylanicum, and Zingiber officinale. Duration of dyslipidemia was significantly longer in herbal users than non-herbal users (p=0.04). Patients believing that concomitant use of conventional drugs and herbal preparations had synergic positive effects in addition to those persuaded that herbal preparations possessed less side effects, were significantly more likely to use medicinal plants (p=0.008 and 0.005, respectively). Additionally, most of the medicinal herb users (87.4%) changed neither the pattern nor the dosage of their medications all during herbal preparations use. Conclusions: This study demonstrated a high prevalence of medicinal plants' use among patients with dyslipidemia, which was associated with the duration of dyslipidemia, patients' viewpoints about herbal preparations' synergic positive effects, and their fewer side effects. [ABSTRACT FROM AUTHOR]

Neuropathy is defined as the damage to the peripheral or central nervous system accompanied by pain, numbness, or muscle weakness, which can be due to congenital diseases or environmental factors such as diabetes, trauma, or viral infections. As current treatments are not sufficiently able to control the disease, studies focusing on the identification and discovery of new therapeutic agents are necessary. Natural products have been used for a long time for the management of different neurological problems including neuropathies. The aim of the present study is to review the current clinical data on the beneficial effects of medicinal plants in neuropathy. Electronic databases including PubMed, Scopus, and Cochrane Library were searched with the keywords 'neuropathy' in the title/abstract and 'plant' or 'extract' or 'herb' in the whole text from inception until August 2017. From a total of 3679 papers, 22 studies were finally included. Medicinal plants were evaluated clinically in several types of neuropathy, including diabetic neuropathy, chemotherapy-induced peripheral neuropathy, carpal tunnel syndrome, and HIV-associated neuropathy. Some studies reported the improvement in pain, nerve function, nerve conduction velocity, and quality of life. Cannabis sativa (hemp), Linum usitatissimum (linseed oil), capsaicin, and a polyherbal Japanese formulation called Goshajinkigan had the most evidence regarding their clinical efficacy. Other investigated herbal medicines in neuropathy, such as Matricaria chamomilla (chamomile), Curcuma longa (turmeric), and Citrullus colocynthis (colocynth), had only one clinical trial. Thus, future studies are necessary to confirm the safety and efficacy of such natural medicines as a complementary or alternative treatment for neuropathy. [ABSTRACT FROM AUTHOR]

A new single-ended primary-inductor converter (SEPIC)-based DC--DC converter suitable for photovoltaic (PV) systems is introduced. The proposed converter has the advantage of continuous input current which reduces the input voltage ripple across the PV panels. Furthermore, it can provide a higher-voltage gain at smaller duty cycles when compared with counterpart SEPIC-based topologies which feature the absence of a coupled inductor. A smaller duty cycle for a given voltage gain translates to a lower-current ripple of the inductors, reduced conduction losses, and alleviated voltage stresses of the semiconductor switches. The proposed converter also benefits from a simpler structure and control scheme. The operational principles and the steady-state analysis are studied under both continuous conduction mode and discontinuous conduction mode. A comparative study between the proposed converter and seven counterpart topologies is also included. A laboratory prototype was built and tested. The experimental results are discussed in light of the theoretical analysis. [ABSTRACT FROM AUTHOR]

Persian scientists of ancient times made a significant contribution to the field of surgery. Among them, Avicenna (980-1037 CE) provided the most detailed presentation of surgical procedures. The present paper aimed to review Avicenna's great medical encyclopedia, Canon of Medicine, on ratqā (a female genital tract anomaly) related to gynecologic diseases. Avicenna was familiar with different causes of female genital tract anomalies. He described their signs, symptoms, natural courses, treatments and outcomes. He also noted that surgery was the only treatment of imperforate hymen or any type of vaginal agenesis. He elaborated interestingly on the operation instruments, patient positioning before operation, and the operation method, complications, post-operative and follow-up care. Although many surgical procedures described were previously mentioned by his Persian, Arab, Greek or Indian predecessors, he extended their comments and techniques in many ways, which shows that he not only pointed out related theories but practiced them himself. [ABSTRACT FROM AUTHOR]

Background: Acute and chronic ethanol consumption causes oxidative stress in the liver and Zingiber officinale Roscoe (ginger) ginger improves the function of the liver Objectives: In the present study, the hepatoprotective effects of ginger extract on liver enzymes, lipid profiles, and indices of oxidative stress, including antioxidant enzymes activity and Malondialdehyde (MDA) against hepatotoxicity induced by ethanol in male rats was evaluated. Methods: Twenty-eight adult male Sprague-Dawley rats were randomly allocated to four groups and were treated daily for 28 days as follows: group I: control (received normal saline), group II: ginger (1 g/kg/day ginger extract solution in saline by oral gavage), group III: ethanol (4 g/kg/day ethanol by oral gavage), and group IV: ginger + ethanol. At the end of the experimental period, obtained sera from blood samples were used for assessment of liver enzymes and lipids, and liver tissue homogenate was used for estimating oxidative biomarkers. Furthermore, total phenolics content and in vitro antioxidant potential of ginger extract was determined to correlate hepatoprotective activity with phytochemical and antioxidant activity. Results: In the ethanol group, the results showed a significant increase in biomarkers of oxidative stress and liver function biomarkers compared to other groups (P < 0.05). The level of altered enzyme markers was ameliorated significantly in the ginger cotreatment (ginger + ethanol) group (P < 0.05), while no significant difference in biochemical parameters were observed in ginger alone and control groups. Conclusions: It can be concluded that ginger extract has protective effects against toxicity induced by ethanol in the liver of male rats. The protective effect may be attributed to the presence of phenolics and flavonoids components. [ABSTRACT FROM AUTHOR]

Objective: Cassia fistula L. fruit extract has been traditionally used in the treatment of pemphigus vulgaris (PV) lesions in Iran. The aim of this study was to determine the efficacy of C. fistula fruit gel on healing time of PV lesions in a clinical setting. Materials and Methods: This was a randomized, double-blind placebo-controlled clinical trial that was performed in dermatology ward at Saadi hospital, affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Right- or left- sided lesions of PV patients on standard systemic treatment were randomized for treatment with either C. fistula fruit gel or placebo prescribed twice daily. The largest diameter of each lesion was measured at the baseline (day 0) and on days 10 and 20. Epithelialization Index (EI), as outcome measure was calculated and compared between the two groups. Results: The present study comprised 20 patients, with overall 82 cutaneous lesions including 41 lesions in the C. fistula fruit gel group and 41 lesions in the placebo group. The EI in the C. fistula fruit gel group was significantly higher than that of the placebo group both on day 10 (65±28vs 30±34; p=0.001) and at the end of the study (91±22 vs 69±49; p=0.003). Conclusion: Topical application of C. fistula fruit gel can be considered as an effective adjuvant therapy in treatment of PV. [ABSTRACT FROM AUTHOR]

Our aim is to assess the effect of cinnamon powder capsules on insulin resistance, anthropometric measurements, glucose and lipid profiles, and androgens of women with polycystic ovarian syndrome (PCOS). Out of 80 women that were diagnosed as PCOS by Rotterdam Criteria, 66 were enrolled in this randomized double-blind placebo-controlled clinical trial. All of the PCOS women were taking medroxy progesterone acetate 10 mg/day for the last 10 days of their menstrual cycles. The cases were randomly allocated to 2 groups. The women in the first group were treated by cinnamon powder capsules 1.5 g/day in 3 divided doses for 12 weeks and the second group by similar placebo capsules. Anthropometric measurements, fasting blood sugar, fasting insulin, blood glucose 2 hr after taking 75 g oral glucose, HbA1c, testosterone, dehydroepiandrosterone sulphate, homeostatic model assessment for insulin resistance, triglyceride, and cholesterol (low-density lipoprotein, high-density lipoprotein, and total) before and after the intervention were evaluated and compared as outcome measures. Fasting insulin (p = .024) and homeostatic model assessment for insulin resistance (p = .014) were reduced after 12 weeks in the cinnamon group compared with the placebo. There was also a significant decrease in low-density lipoprotein in cinnamon group (p = .004) as compared with baseline that caused significant difference with placebo (p = .049). However, changes in other outcome measurements did not lead to statistically significant difference with placebo. The present results suggest that complementary supplementation of cinnamon significantly reduced fasting insulin and insulin resistance in women with PCOS. [ABSTRACT FROM AUTHOR]

Silybum marianum (L) Gaertn (milk thistle) seeds, Urtica dioica L (nettle) leaves, and Boswellia serrata (olibanum gum) resin are used traditionally by Iranian diabetic patients. The aim of this study was to evaluate the antihyperglycemic effects of these herbs in an herbal formulation in patients with type II diabetes mellitus. Sixty patients diagnosed as type II diabetes mellitus with fasting blood glucose level from 150 to 180 mg/dL, glycosylated hemoglobin level from 7.5% to 8.5%, and on oral antihyperglycemic drugs, were allocated to receive the mix herbal formulation or placebo for 90 days in a double-blind randomized placebo-controlled clinical trial. The mean serum fasting blood glucose, glycosylated hemoglobin, and triglyceride in the herbal drug group were significantly less than placebo group’s values after 3 months of the intervention. The study showed a potential antihyperglycemic and triglyceride lowering effect of the herbal formulation, while it did not have any significant cholesterol or blood pressure lowering effect. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate the prophylactic effect of ginger extract on ethanol-induced reproductive toxicity in male rats. Twenty-eight adult male Sprague-Dawley rats were randomly divided into 4 groups and treated daily for 28 days as follows: control, control-ginger (1 g/kg of body weight [BW]/day by gavage), ethanol group (ethanol 4 g/kg of BW/day by gavage), and ginger-ethanol group. At the end of the experiment, all the rats were sacrificed and their testes were removed and used for measurement of the total homocysteine (tHcy), trace elements, antioxidant enzymes activity, and malondialdehyde (MDA). The results in the ethanol group indicate that ethanol decreased antioxidant enzymes activity and increased MDA and tHcy compared with the control groups (P < .05). In ginger-ethanol group, ginger improved antioxidant enzymes activity and reduced tHcy and MDA compared to ethanol group (P < .05). It can be concluded that ginger protects the ethanol-induced testicular damage and improves the hormonal levels, trace elements, antioxidant enzymes activity, and decreases tHcy and MDA. [ABSTRACT FROM AUTHOR]

Aim. To evaluate the efficacy of topical use of Matricaria recutita L oil in the treatment of enuresis in children. Methods. Eighty patients diagnosed as monosymptomatic nocturnal or daytime enuresis were allocated to receive Matricaria recutita L (chamomile) oil or placebo topically for 6 weeks in a double-blind randomized placebo-controlled trial with a parallel design. Patients were evaluated prior to and following 8 weeks of the intervention in terms of frequency of enuresis and any observed adverse events. Results. The mean frequency of enuresis at the first, second, and third 2 weeks was lower in the intervention group compared with the placebo group, and the differences were statistically significant (P < .001, P = .03, and P < .001, respectively). There was no report of any adverse event in the study groups. Conclusion. The findings of this study showed that the topical use of (chamomile) oil can decrease the frequency of nocturia in children with monosymptomatic nocturnal or daytime enuresis. [ABSTRACT FROM AUTHOR]

Background The aim of the present study was to examine the safety and efficacy of a topical formulation of Citrullus colocynthis in patients with painful diabetic polyneuropathy ( PDPN). Methods The study was designed as a two-arm double-blind randomized placebo-controlled clinical trial using a parallel design. Sixty patients with PDPN were randomly allocated to receive either a topical formulation of C. colocynthis or placebo (1:1 allocation ratio) for 3 months. Patients were evaluated before and after the intervention using the neuropathic pain scale, electrodiagnostic findings, World Health Organization Biomedical Research and Education Foundation ( BREF) quality of life ( WHOQOL-BREF) scores, and reported adverse events. Results There was a significantly greater decrease in mean pain score after 3 months in the C. colocynthis (−3.89; 95% confidence interval [ CI] −3.19, −4.60) than placebo (−2.28; 95% CI −1.66, −2.90) group ( P < 0.001). Mean changes in nerve conduction velocity of the tibial nerve, distal latency of the superficial peroneal nerve and sural nerve, and sensory amplitude of the sural nerve were significantly higher in the intervention than placebo group ( P < 0.001) in favour of the intervention. In the different domains of WHOQOL-BREF, there was a significant improvement only for the mean score in the physical domain. Conclusions Application of a topical formulation of C. colocynthis fruit extract can decrease pain in patients with PDPN. It also may have some uncertain effects on nerve function and the physical domain of quality of life, which require further investigation in studies with larger sample sizes and of longer duration. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effect of violet syrup on cough alleviation in children with intermittent asthma. In a parallel, double-blind, randomized controlled trial, 182 children aged 2 to 12 years with intermittent asthma were randomly assigned 1:1 to receive violet syrup or placebo along with the common standard treatments in both groups (short-acting β-agonist). Both groups were evaluated in terms of the duration until cough suppression was achieved. No significant difference was observed in basic characteristics. The duration lasting to yield more than 50% cough reduction and 100% cough suppression was significantly less in the violet syrup group compared to placebo (P = .001, P < .001, respectively). There was no significant difference in therapeutic effects between boys and girls. There was a significant inverse correlation between the age of children and rate of cough alleviation and suppression by violet syrup. This study showed that the adjuvant use of violet syrup with short-acting β-agonist can enhance the cough suppression in children with intermittent asthma. [ABSTRACT FROM AUTHOR]

Allium ampeloprasum subsp iranicum (Leek) has been traditionally used in antihemorrhoidal topical herbal formulations. This study aimed to evaluate its safety and efficacy in a pilot randomized controlled clinical trial. Twenty patients with symptomatic hemorrhoids were randomly allocated to receive the topical leek extract cream or standard antihemorrhoid cream for 3 weeks. The patients were evaluated before and after the intervention in terms of pain, defecation discomfort, bleeding severity, anal itching severity, and reported adverse events. A significant decrease was observed in the grade of bleeding severity and defecation discomfort in both the leek and antihemorrhoid cream groups after the intervention, while no significant change was observed in pain scores. There was no significant difference between the leek and antihemorrhoid cream groups with regard to mean changes in outcome measures. This pilot study showed that the topical use of leek cream can be as effective as a standard antihemorrhoid cream. [ABSTRACT FROM PUBLISHER]

Background: Carpal tunnel syndrome is known as the most common entrapment neuropathy. Conservative treatments cannot reduce the symptomatic severity satisfactorily; therefore, effectiveness of Linum usitatissimum L. (linseed) oil on carpal tunnel syndrome, as a complementary treatment, was evaluated in the current study. Linseed oil is a well-known preparation in Iranian traditional medicine and its analgesic, anti-inflammatory and anti-oxidative effects have been shown in previous studies. Methods: A randomized, double-blind, placebo-controlled clinical trial was conducted. One hundred patients (155 hands) with idiopathic mild to moderate carpal tunnel syndrome aged between 18 and 65 years old were randomized in two parallel groups. These two groups were treated during 4 weeks with topical placebo and linseed oil. In addition, a night wrist splint was prescribed for both groups. Symptomatic severity and functional status were measured using Boston Carpal Tunnel Questionnaire. In addition, median sensory nerve conduction velocity, motor distal latency, sensory distal latency and compound latency as electrodiagnostic parameters were measured at baseline and after the intervention period. Results: After the intervention, significant improvement was observed regarding Boston Carpal Tunnel Questionnaire symptomatic severity and functional status mean differences (p <0.001) in the linseed oil group compared with those in the placebo group. Also, regarding the mean differences of both groups, significant improvement of nerve conduction velocity of the median nerve was seen in the linseed oil group by a value of 2.38 m/sec (p < 0.05). However, motor distal latency and sensory distal latency of the median nerve showed no between-group significant changes (p = 0.14 for both items). Finally, compound latency was improved slightly in the case group, comparing mean differences between the groups (p <0.05). No significant adverse events were reported from using linseed oil. Conclusions: It seems that linseed oil could be effective in the management of mild and moderate carpal tunnel syndrome, especially in improving the severity of symptoms and functional status. In addition, its effect on electerodiagnostic parameters, especially on the nerve conduction velocity, can be considered as a valuable point. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome is known as the most common entrapment neuropathy. Conservative treatments cannot reduce the symptomatic severity satisfactorily; therefore, effectiveness of Linum usitatissimum L. (linseed) oil on carpal tunnel syndrome, as a complementary treatment, was evaluated in the current study. Linseed oil is a well-known preparation in Iranian traditional medicine and its analgesic, anti-inflammatory and anti-oxidative effects have been shown in previous studies. Methods: A randomized, double-blind, placebo-controlled clinical trial was conducted. One hundred patients (155 hands) with idiopathic mild to moderate carpal tunnel syndrome aged between 18 and 65 years old were randomized in two parallel groups. These two groups were treated during 4 weeks with topical placebo and linseed oil. In addition, a night wrist splint was prescribed for both groups. Symptomatic severity and functional status were measured using Boston Carpal Tunnel Questionnaire. In addition, median sensory nerve conduction velocity, motor distal latency, sensory distal latency and compound latency as electrodiagnostic parameters were measured at baseline and after the intervention period. Results: After the intervention, significant improvement was observed regarding Boston Carpal Tunnel Questionnaire symptomatic severity and functional status mean differences (p <0.001) in the linseed oil group compared with those in the placebo group. Also, regarding the mean differences of both groups, significant improvement of nerve conduction velocity of the median nerve was seen in the linseed oil group by a value of 2.38 m/sec (p < 0.05). However, motor distal latency and sensory distal latency of the median nerve showed no between-group significant changes (p = 0.14 for both items). Finally, compound latency was improved slightly in the case group, comparing mean differences between the groups (p <0.05). No significant adverse events were reported from using linseed oil. Conclusions: It seems that linseed oil could be effective in the management of mild and moderate carpal tunnel syndrome, especially in improving the severity of symptoms and functional status. In addition, its effect on electerodiagnostic parameters, especially on the nerve conduction velocity, can be considered as a valuable point. [ABSTRACT FROM AUTHOR]

Diabetic neuropathy is probably the most common complication of diabetes mellitus. Secondary preventive measures for diabetic neuropathy with delaying, stopping or even reversing progressive course of neuropathy, pain control and prevention of ulceration can play important role in diabetic patients care. Oxidative stress plays an important role in pathogenesis of diabetic neuropathy. Treatments for diabetic neuropathy have been mainly focused on two purposes, pain control and repair of nerve injury. Therapeutic options for nerve injuries may not improve or even exacerbate painful symptoms. On the other hand most of treatments for pain control have little or no effect on nerve function. As a result of mentioned discrepancy between 'nerve protection' and 'pain control' in the treatment of painful diabetic neuropathy, it is hypothesized that Citrullus colocynthis as a therapeutic agent with simultaneous antioxidative and anesthetic effects can play an important role in treatment of painful diabetic neuropathy. Previous in vitro and animal studies of C.colocynthis demonstrated its 'antioxidative', 'anesthetic' and 'antiulcerogenic' effects. A randomized controlled double-blind clinical trial is needed to evaluate this hypothesis. [ABSTRACT FROM AUTHOR]

Despite the well-known history of hypertension research in the modern era, like many other cardiovascular concepts, main points in the medieval concept of this disease and its early management methods remain obscure. This article attempts to make a brief review on the medieval origin of the concept of this disease from the Hidāyat of Al-Akhawayni (?-983 AD). This article has reviewed the chapter of "Fi al-Imtela" (About the Fullness) from the Hidāyat al-Muta'allimin fi al-Tibb (The Students' Handbook of Medicine) of Al-Akhawayni. The definition, symptoms and treatments presented for the Imtela are compared with the current knowledge on hypertension. Akhawayni believed that Imtela could result from the excessive amount of blood within the blood vessels. It can manifest with symptoms including the presence of a pulsus magnus, sleepiness, weakness, dyspnea, facial blushing, engorgement of the vessels, thick urine, vascular rupture, and hemorrhagic stroke. He also suggested some ways to manage al-Imtela'. These include recommendations of changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar). Al-Akhawayni's description of "Imtela," despite of its numerous differences with current knowledge of hypertension, can be considered as medieval origin of the concept of hypertension. [ABSTRACT FROM AUTHOR]

Lycopene, belonging to the carotenoids, is a tetraterpene compound abundantly found in tomato and tomato-based products. It is fundamentally recognized as a potent antioxidant and a non-pro-vitamin A carotenoid. Lycopene has been found to be efficient in ameliorating cancer insurgences, diabetes mellitus, cardiac complications, oxidative stress-mediated malfunctions, inflammatory events, skin and bone diseases, hepatic, neural and reproductive disorders. This review summarizes information regarding its sources and uses amongst different societies, its biochemistry aspects, and the potential utilization of lycopene and possible mechanisms involved in alleviating the abovementioned disorders. Furthermore, future directions with the possible use of this nutraceutical against lifestyle-related disorders are emphasized. Its protective effects against recommended doses of toxic agents and toxicity and safety are also discussed. [ABSTRACT FROM AUTHOR]

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common complications in patients with cancer. Citrullus colocynthis (bitter apple) has been used in traditional Persian medicine as an effective pain relief, especially for neuralgia. We designed a pilot clinical trial to evaluate the safety and efficacy of topical C. colocynthis oil in management of CIPN in breast cancer patients. Thirty-four cancer patients with CIPN were randomly enrolled in two arms of a randomized, double-blind, placebo-controlled clinical trial. The patients were treated by topical C. colocynthis oil or placebo, two times per day for 2 months. Functional Assessment of Cancer Therapy/Gynecologic Oncology Group (FACT/GOG)-Neurotoxicity (Ntx) score was set as the primary outcome measure. No significant improvement was observed in the total score of FACT/GOG-Ntx scale (2.40 ± 1.90 vs. 1.05 ± 1.36, p = .879) in drug and placebo groups, respectively. There was also no significant improvement in the mean scores of FACT/GOG-Ntx in the sensory, motor, hearing, and functional domains in the two study groups. According to the results of this preliminary study, topical C. colocynthis oil failed to improve the symptoms of CIPN compared with placebo. [ABSTRACT FROM AUTHOR]

Regarding preclinical evidence for antidiabetic effects of Boswellia serrata, we evaluated antihyperglycemic and lipid-lowering effects of Boswellia serrata gum resin in type 2 diabetic patients. Fifty-six diabetic patients were randomly allocated to 2 groups to receive 250 mg of the Boswellia serrata gum resin or placebo twice daily for 8 weeks in addition to their routine antidiabetic treatments. Although there was a considerable reduction after the intervention in the field of fasting blood sugar, glycosylated hemoglobin, and triglyceride in the Boswellia serrata gum resin group, no significant difference was observed in all outcome measures between the 2 groups at the end of the study. The current study showed that 8 weeks of complementary use of Boswellia serrata gum resin with a daily dose of 500 mg had no better glucose and lipid-lowering effect than placebo in diabetic patients. [ABSTRACT FROM AUTHOR]

Our aim is to assess the effect of cinnamon powder capsules on insulin resistance, anthropometric measurements, glucose and lipid profiles, and androgens of women with polycystic ovarian syndrome (PCOS). Out of 80 women that were diagnosed as PCOS by Rotterdam Criteria, 66 were enrolled in this randomized double-blind placebo-controlled clinical trial. All of the PCOS women were taking medroxy progesterone acetate 10 mg/day for the last 10 days of their menstrual cycles. The cases were randomly allocated to 2 groups. The women in the first group were treated by cinnamon powder capsules 1.5 g/day in 3 divided doses for 12 weeks and the second group by similar placebo capsules. Anthropometric measurements, fasting blood sugar, fasting insulin, blood glucose 2 hr after taking 75 g oral glucose, HbA1c, testosterone, dehydroepiandrosterone sulphate, homeostatic model assessment for insulin resistance, triglyceride, and cholesterol (low-density lipoprotein, high-density lipoprotein, and total) before and after the intervention were evaluated and compared as outcome measures. Fasting insulin (p = .024) and homeostatic model assessment for insulin resistance (p = .014) were reduced after 12 weeks in the cinnamon group compared with the placebo. There was also a significant decrease in low-density lipoprotein in cinnamon group (p = .004) as compared with baseline that caused significant difference with placebo (p = .049). However, changes in other outcome measurements did not lead to statistically significant difference with placebo. The present results suggest that complementary supplementation of cinnamon significantly reduced fasting insulin and insulin resistance in women with PCOS. [ABSTRACT FROM AUTHOR]

Objectives: To examine the safety and efficacy of Citrullus colocynthis (C. colocynthis) topical formulation to treat patients suffering from painful diabetic polyneuropathy (PDPN). Materials and Methods: The study was designed to be a two-arm, double-blind randomized placebo-controlled clinical trial, using a parallel design. Sixty patients with painful PDPN were randomly assigned to receive either the topical formulation for C. Colocynthis (1:1 allocation ratio) or receive the placebo, throughout the duration of the experiment, three months. Patients were then evaluated both before and after the intervention in terms of the Neuropathic Pain Scale, electro-diagnostic findings, World Health Organization BREF quality of life scores and any reported adverse events. Results: The mean changes in pain score were significantly higher in the C. Colocynthis group (3.89, CI: 3.19-4.60) than the scores observed in the placebo group (2.28, CI: 1.66- 2.90) (p value< 0.001). Mean changes in nerve conduction velocity of the tibial nerve, distal latency of the superficial peroneal and sural nerve, as well as sensory amplitude of the sural nerve in the intervention group were statistically significantly higher than those observed in the placebo group (p value< 0.001). No statistically significant differences were seen between the mean changes in values of any other nerve conductions. In the different domains of WHOQOL-BREF, only the mean change in scores of physical domain had shown any significant improvements, when compared to the placebo group Conclusion: Application of topical formulation of C. Colocynthis fruit extract has been shown to significantly decrease pain in patients suffering with PDPN. However, it also may have some uncertain and unknown effects on nerve functions and the physical domain of quality of life. As a result further investigations into studies with larger samples and of longer duration are required, before applications of this formulation is widely used as a viable treatment method.(Clinical Trials.gov ID: NCT02155361) [ABSTRACT FROM AUTHOR]