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Introduction: Multiple sclerosis (MS) is a chronic and debilitating disease that not only leads to disability and associated condition but also impacts one's ability to maintain a professional life. People's acceptance and utilization of medicinal plants (MPs) play an important role in managing their treatment process. As a result, this study aims to investigate the use of medicinal herbs among patients with MS. Methods: A descriptive cross-sectional study was conducted on 150 MS patients who visited a private clinic and the MS Association in Kerman, Iran in 2021. A questionnaire comprising questions about sociodemographic information, disease variables, and aspects of MPs usage was utilized for data collection. Statistical analysis was performed using SPSS version 20 (SPSS Inc., Chicago, IL). The Chi-square test was employed to identify any association between demographic characteristics and MPs usage. To determine the prevalence of plant use in a specific area and the consensus among informants, the use value (UV) and Informant consensus factor (Fic) were calculated. Results: The study revealed a high prevalence of MPs usage among MS patients. Chamomile (66.6%) and golegavzaban (62.0%) were the most commonly used plants with the highest UV indices (0.88 and 0.82 respectively), while St. John's wort and licorice were rarely used (0.67% and 4% respectively). Participants cited pursuing a healthier lifestyle as the primary reason for using MPs (24%). St. John's wort, lavender, and chamomile were the most satisfying plants (100%, 100%, and 53.0% respectively). Chamomile had the highest Fic too. Most patients were motivated to get MPs from their relatives. Conclusions: Given the widespread use of MPs among MS patients, neurologists should enhance their knowledge in this area to guide patients away from seeking advice from non-professionals. Providing standardized formulations can help prevent potential interactions between MPs and mainstream drugs, thereby improving patients safety and outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: There is increasing interest worldwide in using alternative and complementary approaches for treating male infertility. This interest has spawned a multitude of published systematic reviews and meta‐analyses. The aim of this Umbrella review was to consolidate the available evidence regarding the effect of complementary and alternative medicine on male infertility to inform clinical decision‐making processes. Methods: A comprehensive search was conducted to identify systematic reviews and meta‐analyses pertaining to the effects of complementary and alternative medicine on male infertility. This search encompassed various databases including MEDLINE, CINAHL, PubMed, Scopus, Proquest, Google Scholar, SID, EMBASE, Magiran, Cochrane Library, Iranmedex, ScienceDirect, SAGE. Subsequently, two researchers independently extracted the data from the selected meta‐analyses and systematic reviews, and evaluated their methodological quality using the assessment of multiple systematic reviews 2 (AMSTAR2). Results: This analysis encompassed 11 studies, with four originating from Iran, two from Korea and five from China. The results regarding the effectiveness of complementary and alternative medicine are controversial, indicating a need for further research. The methodological quality of the systematic reviews and meta‐analyses appraised by AMSTAR 2 was rated as low or critically low. This assessment is attributed to inadequate examination of publication biases in the reviews and a lack of discussion regarding the effect of risk of bias. Conclusion: The existing evidence regarding the effectiveness of alternative and complementary medicine in addressing male infertility is limited. Furthermore, the overall methodological quality of the published systematic reviews and meta‐analyses may have been underestimated as the use of AMSTAR2 appears to be a more precise appraisal instrument compared to its predecessor. [ABSTRACT FROM AUTHOR]

Background: It is hypothesized that fenugreek seeds are a rich source of fiber with anti-diabetic effects, which can help to lower blood glucose in patients with polycystic ovary syndrome (PCOS). In this study, the clinical and metabolic effects of fenugreek were compared to those of metformin in women with PCOS aged 16-40 years. Methods: In a randomized, triple-blind, parallel clinical trial, the efficacy of fenugreek 333 mg (n=55) was compared with metformin 500 mg (n=55), both administered three times a day in women with PCOS of reproductive age. Changes in some clinical outcomes and metabolic laboratory profile outcomes were evaluated at baseline and two months after the study. Results: By the end of the intervention period, all investigated factors improved significantly in patients of both groups (p<0.05). Reduction in biometric indices (body mass index and waist–hip ratio), fasting blood sugar (FBS), and insulin resistance was significantly higher after metformin consumption (p<0.001). Metformin also significantly improved irregular menstruation (p=0.02). In contrast, fenugreek significantly improved patients' lipid profiles, including low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) compared to metformin (p<0.001). Both interventions improved the patient's hair loss and hirsutism. Conclusion: Fenugreek cannot substitute metformin in PCOS treatment. However, regarding its lipid-lowering ability and low frequency of adverse effects, it can be used as an adjuvant treatment in PCOS, especially in PCOS patients with hyperlipidemia and severe hair loss. [ABSTRACT FROM AUTHOR]

Background Herb shops are important for preparing medicinal plants. Improper packaging can lead to contamination of these plants by various types of microorganisms, fungi and yeasts. Objective This study aims to investigate the prevalence of microbial and fungal contamination in four plants from the Lamiaceae family in herb shops in Rasht, Iran. Methods In this study, 15 samples from mint, rosemary, and wild mint plants, and 16 samples from lemon balm were collected. The samples were diluted and incubated for one hour, then transferred onto Tryptic soy agar culture medium for bacterial enumeration. The sabouraud dextrose agar culture medium was used to count total mold and yeast, while McConkey Broth culture medium was used for specific identification of Escherichia coli. Data analysis was conducted in SPSS software, version 16. For comparing the bacterial and fungal contamination levels in the plant samples with the Pharmacopeial quality standard values, the non-parametric Wilcoxon signed rank test was used. Results Out of 61 plant samples, 59 (73.7%) were contaminated with bacteria, and 60 samples (86.6%) were contaminated with fungi. The number of samples contaminated with Escherichia coli was 27 (44.2%). The mean counts of bacteria and fungi in the plant samples were 3.39×105 and 6.3×105, respectively. Conclusion The microbial contamination in most of the plant samples examined in this study is significantly higher than the permissible limit. It is necessary for health authorities to implement stricter policies for monitoring the quality of natural products in herb shops of Rasht, Iran. [ABSTRACT FROM AUTHOR]

Aim: Our objective was to assess the efficacy and safety of adding alpha-pinene (a herbal terpenoid) to quadruple therapy compared to a placebo in improving symptoms and Helicobacter pylori (H. pylori) eradication rates in Functional dyspepsia (FD) patients. Background: FD is a prevalent upper gastrointestinal condition, and no definitive pharmacological treatment is available for its management. Methods: We conducted a randomized, double-blinded, placebo-controlled trial on FD patients diagnosed with H. pylori infection. We collected baseline demographic data and assessed FD symptoms in the participants. Patients were randomly allocated to receive either standard quadruple therapy with α-pinene capsules (0.25 mg/day) or quadruple therapy with a placebo for two weeks. We employed a validated questionnaire, the Short Form Leeds Dyspepsia Questionnaire (SF-LDQ), to evaluate FD symptoms. The eradication rate of H. pylori was compared between the two groups one month after completing the treatment regimens. Any reported adverse drug reactions (ADRs) were documented throughout the trial. Results: Over four months, a total of 66 patients completed the trial. Notably, there were no significant differences in baseline SFLDQ scores between the two groups (p=0.83); however, a significant divergence emerged at the trial's conclusion (p=0.03). The H. pylori eradication rates did not show notable differences between the two treatment arms (p=0.43). Importantly, there were no dropouts from the trial due to ADRs. Among reported ADRs, participants experienced abdominal pain, headache, diarrhea, and a metallic taste, with no significant variance in incidence rates observed between the two groups (p=0.62). Conclusion: These findings suggest that α-pinene could be an effective and safe agent for reducing FD symptoms. [ABSTRACT FROM AUTHOR]

Herbal components are highly useful assets for the advancement of novel antibacterial drugs. Nanotechnology holds great promise as an approach to enhance the effectiveness and develop the composition of these substances. The study developed nanogels incorporating camphor, thymol, and a combination derived from the initial nanoemulsions with particle sizes of 103, 85, and 135 nm, respectively. The viscosity of nanogels and the successful loading of compounds in them were examined by viscometery and ATR-FTIR studies. The bactericidal properties of the nanogels were examined against four bacterial strains. The nanogel containing camphor and thymol at 1250 µg/mL concentration exhibited complete growth suppression against Pseudomonas aeruginosa and Staphylococcus aureus. The thymol nanogel at 1250 µg/mL and the camphor nanogel at 2500 µg/mL exhibited complete inhibition of growth on Listeria monocytogenes and Escherichia coli, respectively. Both nanogels showed favorable effectiveness as antibacterial agents and could potentially examine a wide range of pathogens and in vivo studies. [ABSTRACT FROM AUTHOR]

Background and Aim: COVID-19 pulmonary manifestations vary from mild pneumonia to acute respiratory distress syndrome. Regarding the lack of specific treatment, its wide range of clinical manifestations, and especially the similarity of manifestation to different types of pneumonia in Persian medicine references, this research wants to review pneumonia from the viewpoint of traditional Persian medicine. Methods: In this review study, the keywords of "zat-alrrieh", and "awram-e-rieh" were searched in the most important Persian medicine references. The results were classified and concluded. Results: In traditional Persian medicine references, diagnosis of diseases is mainly according to clinical manifestations of each patient. In those references, pneumonia is considered as hot inflammation of the lung. There are different clinical manifestations and treatments concerning the pathologic Khelt (Humor) and stage of the disease. The goals of treatments are regulating Mizaj (Temperament), excretion of pathologic Khelt, and body empowerment. In addition to diet modification and oral medication, topical medication such as anointment, poultice, enema, cupping, gargling, and aromatherapy and manual therapies such as bloodletting are recommended to treat pneumonia. Conclusion: Due to the similarity of manifestations of pneumonia especially emerging COVID-19 pneumonia to described pneumonia in Persian medicine references and the reports of successful experiences in the application of traditional treatment, clinical trials to evaluate the effect of Persian medicine treatments especially as a treatment package are recommended. [ABSTRACT FROM AUTHOR]

Background: Herbal medicines are the preferred anticancer agents due to their lower cytotoxic effects on healthy cells. Plant lignans play an important role in treating various diseases, especially cancer. The present study aimed to evaluate the effect of podophyllotoxin, pinoresinol, and lariciresinol on cellular toxicity and inducing apoptosis in fibroblasts, HEK-293, and SkBr3 cell lines. Methods: An in vitro study was conducted from 2017 to 2019 at the Faculty of Biological Sciences, Tarbiat Modares University (Tehran, Iran). The cell lines were treated for 24 and 48 hours with different concentrations of lignans. Cell viability and apoptosis were examined using MTT and flow cytometry, respectively. Expression levels of cell cycle and apoptosis regulator genes were determined using quantitative real-time polymerase chain reaction. Data were analyzed using a two-way analysis of variance followed by Tukey's HSD test. P<0.05 was considered statistically significant. Results: Podophyllotoxin significantly increased apoptosis in fibroblast cells compared to pinoresinol and lariciresinol (P<0.001). The percentage of cell viability of fibroblast cells treated for 48 hours with pinoresinol, lariciresinol, and podophyllotoxin was reduced by 49%, 47%, and 36%, respectively. Treatment with pinoresinol and lariciresinol significantly overexpressed pro-apoptotic genes and underexpressed anti-apoptotic genes in SkBr3 cells (P<0.001). SkBr3 cells treated with lariciresinol significantly reduced gene expression (P<0.001). Conclusion: Pinoresinol and lariciresinol can potentially be used as new therapeutic agents for the treatment of breast cancer. [ABSTRACT FROM AUTHOR]

Background and Aim: Chronic neuropathic pain is one of the common and debilitating problems of human societies and is a challenge in health care Valerian officinalis has been used in the treatment of pain and anxiety due to its antioxidant effects and multiple mechanisms. Also, the medicinal form of emulsion is studied to increase the bioavailability and absorption of herbal products. The present study was conducted to determine the analgesic and anti-anxiety effects of the oral emulsion of the extract and compare it with the effects of the extract in adult male rats. Methods: First, the oral emulsion of the extract was formulated with the help of similar studies and Design Expert software, and the best formulation was selected. Then, neuropathic pain was induced in the animals with the help of a sciatic nerve chronic obstructive lesion (CCI) neuropathy surgical model. The extract and emulsion were given orally (gastric gavage) to the animals for 30 days, after which behavioral tests were performed, to investigate thermal allodynia, and elevated plus maze (EPM), to investigate induced anxiety behaviors, one day before Induction of neuropathy and on days 2, 4, 6, 10, 14, 21, 30 after neuropathy were investigated, and at the end, the effects of oral emulsion gavage of extract and extract on lipid peroxidation of malondialdehyde (MDA) in brain tissue were investigated and compared. Results: Separate administration of valerian extract and emulsion reduced cold allodynia in all days after CCI surgery compared to the neuropathy group (P<0.05). In addition, CCI surgery caused anxiety in rats. Administration of valerian emulsion and its extract were able to significantly reduce anxiety in the behavioral test of the plusshaped elevated maze. The difference is that this reduction process started earlier with the administration of the extract emulsion (P<0.001). Also, the administration of the extract and emulsion significantly reduced the amount of malondialdehyde in the brain tissue in neuropathic rats compared to the neuropathy group (P<0.001), with the difference that the emulsion of the extract caused a greater decrease in the amount of malondialdehyde compared to the extract. Conclusion: Valerian extract and emulsion have analgesic and anti-anxiety effects. In addition, the administration of valerian emulsion in neuropathic rats has significantly more anti-anxiety and analgesic effects compared to the administration of valerian extract. [ABSTRACT FROM AUTHOR]

Patients living with a permanent ostomy encounter many physical, psychological, and social challenges due to the loss of function of a part of their body. Today, as the use of alternative therapies increases, some of these patients are seeking complementary medicine to relieve the symptoms and complications of their disease. Therefore, the present study aimed to determine the use of, reasons for, and satisfaction with the complementary medicine among patients living with a permanent ostomy. This descriptive cross-sectional study was conducted on 100 patients living with a permanent ostomy who were referred to ostomy clinics in southeastern Iran. The census method was used for sampling. The research tool included a complementary medicine questionnaire. SPSS-25 was used for data analysis. The results showed that in physical methods, most of the participants used herbal medicines (83%), aromatherapy (79%), vitamin supplements (76%), and diet (66%). In mental methods, most of the participants used prayer/recourse/vow (91%) and music therapy (75%) (every day to several times a year). People with university education (p < 0.001), higher incomes (p = 0.002), and history of addiction (p = 0.048) used more methods of complementary medicine. Fifty-three point four of the participants used herbal medicines to reduce physical complications, 46.6% used them to improve anxiety and stress induced by ostomy, and between 66 and 80% was completely satisfied with the use of various types of complementary medicine. The study results showed that the frequency of complementary medicine use among patients living with a permanent ostomy varied from a few days to several years. Considering the use of complementary medicine by these patients, educational programs, and interventions are necessary to increase the general awareness of ostomy patients about the types of complementary and alternative medicine (CAM) and the effects of these methods. [ABSTRACT FROM AUTHOR]

In the great Persian Empire, pomegranate (Punica granatum L.) had a wide reputation for use both as an herbal medicine and nutritious food. It was also a symbol of peace and love according to Achaemenid limestones in the great Persia. This paper aims to review the traditional uses of pomegranate in Persian and Islamic traditional medicine and have thorough and current information regarding the pharmacology and phytochemistry of this valuable plant for practical use and further research. Relevant information about P. granatum was collected from scientific publishers and databases including Elsevier, Wiley, PubMed, and Google Scholar between 1950 and 2022. The traditional knowledge was extracted from Persian and Islamic traditional textbooks. Based on traditional textbooks, pomegranate has beneficial effects on diseases related to gastrointestinal, upper and lower respiratory, visual, and reproductive systems. In addition, pomegranate and its preparations have been prescribed for treating metabolic disorders, skin problems, and wounds as well as dental protection. Preclinical and clinical evidence supports many therapeutic potentials of pomegranate in traditional medicine. Its therapeutic effects are mostly attributed to its polyphenols. The knowledge in Persian and Islamic traditional textbooks about pomegranate and its preparations can be used as a guide for further preclinical and mainly clinical studies to discover the therapeutic potential of this valuable plant. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease 2019 (COVID-19) has caused some major changes in occupational patterns that form part of the individual's occupational identity. Due to debilitating symptoms, post-COVID-19 survivors with limitations in the occupational performance areas may experience occupational imbalance. The objective of this study was to investigate the methods employed by patients to engage in their daily activities for regaining occupational balance. Methods: The study used an interpretive paradigm and conventional content analysis. An in-depth semi-structured interview was conducted with 11 patients who had been hospitalized due to COVID-19 in the past 6 months or less, along with their three primary caregivers residing in Tehran. The sampling method used was purposive and continued until conceptual saturation was reached. Participants with the most tremendous possible diversity in demographic variables were included. Data were analyzed using Corbin and Strauss's recommended Constant Comparative Analysis. Results: The findings showed that patients used different strategies which included self-treatment based on others' recommendations, compensatory, fatigue prevention and adaptive strategies to restore occupational balance. Conclusion: As occupational therapists, we must understand post-COVID-19 survivors' perspectives on occupations and their preferred strategies. Also, findings confirm that occupational balance is a dynamic process that the adaptive capacities of the patients help to restore occupational balance. [ABSTRACT FROM AUTHOR]

Introduction: Flavonoids are a group of polyphenolic compounds naturally found in plants. Many flavonoids are the basis of herbal medicines and have effective pharmacological effects. Rutin is one of the flavonoids used as a reagent in the study of flavonoids and is also considered an antioxidant. This study was conducted to isolate and identify rutin-producing endophytic fungi from C. spinosa. Materials and Methods: Sampling was performed in 10 regions of Iran and was taken from different tissues (including leaves, stems, roots, and fruits). After surface disinfection, explants were placed on a PDA medium and the fungal isolates were purified. Molecular identification of isolates was performed by sequencing ITS1-5.8S-ITS2. Morphological identification of fungi was performed by microscopic slide preparation and fungus identification keys. Methanolic extract of fungi was prepared by the maceration method and the presence of rutin was investigated using the HPLC technique. Results: A total of 24 fungi were identified. HPLC analysis showed that the peak of standard flavonoids including rutin, quercetin, and apigenin appeared at 3.82, 7.60, and 12.40 min, respectively. Results showed that only two isolates were able to produce rutin. A comparison of the mean production of rutin showed a significant difference between the two fungi. Alternaria alternata M28 (22.94 ppm) had the highest amount of rutin production. Results also showed that rutin production in the mycelial tissue was more than in the extracellular medium, so A. alternata M28 and Paecilomyces maximus M7 had rutin content of about 67.5 and 5.56 times, respectively. Discussion and Conclusion: Fungal rutin in methanolic extracts was characterized by HPLC. This is the first report showing that endophytic fungi have a potential for rutin production from C. spinosa and more research on these isolates can increase the amount of rutin production in them and lead to the possible commercialization. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the role of Iranian herbal Zofa® syrup in improving the clinical symptoms of patients with COVID-19. Materials and Methods: This randomized clinical trial was conducted on 105 patients with COVID-19. Patients were randomly assigned to the intervention (n=35) group (received 10 ml of Zofa® syrup every 8 hours/seven days plus standard treatment) or the control (n=70) group (received only standard treatment). Assessments were performed before and after treatment. Results: The groups were comparable regarding age (p=0.980), gender (p=0.584), comorbidities (p=0.318), or drug history (p=0.771). There was no difference between patients' recovery status at the time of discharge (p=0.327) or two weeks postdischarge (p=0.165) in the intervention and control groups. No patient was hospitalized to the intensive care unit (ICU) for supplemental oxygen therapy and no patient died in the intervention group. However, in the control group, three (4.5%) patients were transferred to the ICU, and two (3.03%) patients died. Conclusion: Considering the better recovery status of the patients at the time of discharge and the absence of patient deaths in the intervention group, more additional studies are needed to confirm these findings and elucidate the role of Zofa® in COVID-19. [ABSTRACT FROM AUTHOR]

Background: Functional constipation (FC) is a common major problem in children. This study compared Jujube paste and polyethylene glycol (PEG) as laxative drugs in children with FC. Ziziphus Jujuba Mill (Jujube) was selected according to traditional Iranian medicine because it is native to Iran and a large extent of Asia, is safe and easy to access, with acceptable taste to children. Methods: This randomized controlled clinical trial was performed on 128 children aged 2 to 12 with FC according to Rome IV criteria. Patients were randomly divided into two groups of Jujube paste and PEG and underwent four weeks of treatment. The efficacy, safety, and tolerability of the Jujube oral product were compared with PEG. Results: Following four weeks of therapy, all clinical symptoms of constipation according to Rome IV criteria were improved significantly in both groups (P< 0.05). In all the seven criteria of Rome IV, Jujube paste was as effective as PEG and even stronger in reducing stool stiffness (P< 0.0001). No hazardous side effect was reported in the two groups. Moreover, the medication acceptance rate was higher in the group receiving Jujube paste than in the group receiving PEG. Conclusions: Jujube paste is as effective as PEG in pediatric FC. This product has high nutritional value and antioxidant properties, so it can be a safe substitute for PEG in pediatric FC. [ABSTRACT FROM AUTHOR]

Since ancient times, people around the world have used natural cosmetics to improve or change the appearance of their nails, skin, and hair. Henna is a plant-based dye that has been used over the centuries for medical and cosmetic purposes. The present work was aimed to investigate the presence of lead (Pb) and arsenic (As) in various types of commonly consumed henna samples in Iran. A total of thirty-nine henna samples from both local and imported products (3 colors in 13 brands) were randomly collected from popular and herbal medicine markets. The atomic absorption spectrometry (AAS) technique was used for the analysis of the samples. The amount of Pb and As in 100% samples was higher than the calculated limit of quantitation (LOQ). The concentrations of Pb and As in the samples were at the ranges of 9.56–16.94 μg/g and 0.25–1.12 μg/g, respectively. The mean level of Pb was higher in black and red products, compared with the green henna. The levels of Pb and As in 53.85% and 7.7% of the henna samples exceeded the permissible limits recommended by the World Health Organization (WHO), respectively. In addition, the mean levels of Pb and As contamination in the imported samples were significantly higher, in comparison to the local henna samples. To our knowledge, this is the first study assessing Pb and As contamination in the henna samples consumed in Iran. Our study demonstrated that there is a potential risk of exposure to Pb through henna in the Iranian consumers. [ABSTRACT FROM AUTHOR]

Background: Oral mucositis (OM), an acute inflammation of the oral cavity, is a common complication in patients undergoing invasive myeloblastic chemotherapy or radiation therapy. 5-fluorouracil (5-FU) is one of the most effective therapeutic drugs, but one of the common side effects of 5-FU administration is OM. Unfortunately, no suitable treatment has been found, so far to control its side effects. Studies showed that herbal medicine like Punica granatum var pleniflora (PGP) has medicinal properties such as anti-inflammatory and antibacterial and can be an alternative for the treatment of fungal infection. Accordingly, we decided to investigate the therapeutic effect of PGP in the treatment of OM caused by 5-FU in golden hamsters. Methods: Sixty male golden hamsters were divided into six main group. Chemotherapy with 5-FU at dose of 60 mg/kg was performed at a ten-day duration. Then, cheek pouches of the hamsters were scratched with an 18-gauge sterile needle to induce oral mucositis in animals. On the twelfth day, as a day of intensification of OM, treatment with PGP including topical gel with concentrations of 5% and 10% and oral administration of hydro-alcoholic extract with doses of 125 mg/kg and 250 mg/kg for three- and five-day therapeutic duration were separately started. Finally, samples of cheek pouches in hamsters were collected on 14th and 17th days and histopathologic score (HPS), malondialdehyde (MDA), and myeloperoxidase (MPO) levels were assayed. Results: A significant (p < 0.05) decrease in histopathologic score was observed in G10%−, P125-treated groups in comparison to the Ctrl group. Our data showed that treatment with G10% is more potent than P125-treated group. In contrast, histopathologic score in G10%, P125, and P250 treated groups demonstrated almost similar values On the 17th day. However, the levels of MDA and MPO in the treatment groups were enhanced compared with control group (p < 0.05). Conclusions: It is possible that PGP can play protective role in the healing of tissue damage caused by chemotherapy with 5-FU due to the presence of its natural compounds and antioxidant properties. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify factors affecting the behavioral intention of Iranian rural women to use medicinal herbs. The research model was developed by integrating "dissatisfaction with modern medicine" into the "theory of planned behavior". Methods: Data were collected through questionnaire from a sample of 260 Iranian rural women, which were randomly selected. The validity and reliability of the scale were confirmed using expert opinions and Cronbach's alpha method, respectively. Results: Based on the results of structural equation modeling, attitude (β = 0.44; p < 0.01), subjective norms (β = 0.27; p < 0.01) and dissatisfaction with modern medicine (β = 0.11; p < 0.05) had significant positive effects on rural women's intention to use medicinal herbs. In addition, subjective norms indirectly affected rural women's intention to use medicinal herbs through attitude (β = 0.23; p < 0.01). Conclusions: Subjective norms was a key factor in determining the intention of Iranian rural women to use medicinal herbs, followed by attitude and dissatisfaction with modern medicine. Therefore, this study could contribute to our understanding on how the intention of Iranian rural women to use medicinal herbs was influenced by different factors. [ABSTRACT FROM AUTHOR]

Senna Mill. (Fabaceae) is an important medicinal plant distributed worldwide. Senna alexandrina (S. alexandrina), the officinal species of the genus, is one of the most well-known herbal medicines traditionally used to treat constipation and digestive diseases. Senna italica (S. italica), another species of the genus, is native to an area ranging from Africa to the Indian subcontinent, including Iran. In Iran, this plant has been used traditionally as a laxative. However, very little phytochemical information and pharmacological reports investigating its safety of use are available. In the current study, we compared LC-ESIMS metabolite profiles of the methanol extract of S. italica with that of S. alexandrina and measured the content of sennosides A and B as the biomarkers in this genus. By this, we were able to examine the feasibility of using S. italica as a laxative agent like S. alexandrina. In addition, the hepatotoxicity of both species was evaluated against HepG2 cancer cell lines using HPLC-based activity profiling to localize the hepatotoxic components and evaluate their safety of use. Interestingly, the results showed that the phytochemical profiles of the plants were similar but with some differences, particularly in their relative contents. Glycosylated flavonoids, anthraquinones, dianthrones, benzochromenones, and benzophenones constituted the main components in both species. Nevertheless, some differences, particularly in the relative amount of some compounds, were observed. According to the LC-MS results, the amounts of sennoside A in S. alexandrina and S. italica were 1.85 ± 0.095% and 1.00 ± 0.38%, respectively. Moreover, the amounts of sennoside B in S. alexandrina and S. italica were 0.41 ± 0.12 % and 0.32 ± 0.17%, respectively. Furthermore, although both extracts showed significant hepatotoxicity at concentrations of 50 and 100 µg/mL, they were almost non-toxic at lower concentrations. Taken together, according to the results, the metabolite profiles of S. italica and S. alexandrina showed many compounds in common. However, further phytochemical, pharmacological, and clinical studies are necessary to examine the efficacy and safety of S. italica as a laxative agent. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is a very common chronic disease among children. As for its treatment, in recent years there is an increased tendency towards supplemental treatments. Hence, many of these patients are administered complementary and alternative treatments including herbal medicine. Methods:Through a cross-sectional study, we evaluated the common herbal remedies used in asthmatic children referred to the allergy clinic of Sarvar Children's Hospital in Mashhad. All data related to the patients (i.e., age, sex, and history of all remedies consumed as well as the responsible persons prescribing the pertinent medications) were recorded in a checklist. Results: In this study, 582 asthmatic children with the average age of 41.7±77.4 months were evaluated. The overall herbal remedies usage was %59.8. There was no significant differences between age groups, sex, or asthma severity and herbal remedy usage. Thirty-seven different herbal remedies were prescribed to the patients, the most common herb was thymes (%65.3) followed by a four-seed herbal mixture (%23.6), Plantago major (%12) and Cydonia oblonga (quince) (%10.8). Conclusion:Limited information is available regarding complementary and alternative medicine in asthmatic children in Iran. The present study showed the high prevalence of herbal medicine usage in asthmatic children in this region. Hence, further studies should determine the clinical benefits of these remedies. [ABSTRACT FROM AUTHOR]

Background: Burn wounds rank among the most serious healthcare issues. Many studies reported the effectiveness of natural products in the wound-healing process. The present study compared the effects of a standardized herbal formulation derived from Boswellia carteri (B. carteri) and silver sulfadiazine (SSD) cream 1% on the healing of burn wounds. Methods: This randomized double-blind clinical trial was conducted at Shiraz Burn Hospital (Shiraz, Iran) between July 2012 to August 2013. A sterilized formulation comprising B. carteri 40% was prepared. 54 second-degree burn patients of both sexes with age ranges of 20 to 60 were invited to participate in this double-blind, randomized clinical trial. They were randomly divided into two groups and given either the Boswellia formulation or SSD cream. The healing index was determined based on the wound area assessment using the planimetry technique. The Kaplan-Meier survival analysis was used to assess the primary outcome, which was the amount of time until complete healing. Results: The trial was completed by 17 patients from the SSD group and 15 patients from the Boswellia group. During the study period, both groups showed a progressive healing trend. The mean (95% CI) healing time in the SSD group was 10.94 (9.03-12.85) days and 10.73 (9.23-12.23) days in the Boswellia group (P=0.71), indicating no significant difference. On the 17th day, the healing index of all patients in the Boswellia group reached 1. Conclusion: Boswellia topical formulation had a burn wound healing effect comparable to that of the standard SSD 1% treatment. Based on the findings of this study, the likelihood of contact dermatitis with Boswellia should be taken into consideration. [ABSTRACT FROM AUTHOR]

Successful pain management in patients with cancer is a significant challenge, and paying more attention to patients' experiences of pain self-management strategies has particular importance. This study aimed to explore pain self-management strategies in Iranian patients with cancer. This qualitative study was conducted on 14 patients with cancer. Data were collected using semistructured interviews and analyzed through the Graneheim and Lundman content analysis approach. Two main categories emerged from data analysis: (1) psychological pain self-management strategies, and (2) behavioral pain self-management strategies. Psychological strategies included pain distraction techniques, spiritual tendencies, increasing social interactions and support networks, pain tolerance and self-control, and resistance to pain. Behavioral strategies included massage and touch, heat and cold therapy, opium (Taryak in Persian) and tobacco use, herbal and home remedies, and proper diet. [ABSTRACT FROM AUTHOR]

Rose hip (Rosa canina L.), as a valuable medicinal herbs of Iran, has beneficial effects on the human health. High dose of the rosehip should be used to be effective on the health and anti-inflammatory activity, but it is difficult especially due to its flavor and texture. Therefore, the main goal of the research was to produce rosehip concentrate to increase the bioactive components in the extract and promote the health. Therefore, the effect of ethanol concentration (20-96%), solvent/solid (S/S) ratio (5:1- 15:1 ml/g) and the extraction time (6-24 h) on the components of the extracted samples of rosehip was investigated to select the treatment with the highest bioactive components. The results indicated that increasing of the S/S ratio enhanced all of the components; although the extraction time hadn’t any significant effects on the extraction yield. Increasing the ethanol concentration enhanced total flavonoid content (TFC) and total carotenoid (TC) and decreased total phenol content (TPC). Therefore, to obtain the highest TC and TFC (at optimum condition including S/S ratio 14.94 ml/g, time of 6 h and 96 % ethanol) and highest TPC (at optimum condition including S/S ratio 15 ml/g, time of 6 h and 35.8 % ethanol), two stages extraction was selected. Finally, these two obtained extract were combined and concentrated under vaccum condition at 45 °C and then, freeze dried. The highest total triterpenoid content (8 % triterpenoid per weight of extract powder) was related to the two staged extract. [ABSTRACT FROM AUTHOR]

A holistic concept based on traditional Persian medicine (TPM) describes a headache with a gastrointestinal (GI) origin (gastric-headache). Although the neurological manifestations of this headache are similar to those of other headaches, its etiology is different. Considering its simultaneous effects on the brain and GI system, a formulation was designed based on this concept. This study aimed to determine the safety and efficacy of the designed formulation on migraine headache (MH) associated with functional dyspepsia (FD). A total of 75 diagnosed cases of MH patients with concurrent FD were randomly divided equally into 3 groups: (i) the polyherbal formulation, sodium valproate (VPA), and amitriptyline group, (ii) VPA, amitriptyline, and polyherbal formulation placebo group, and (iii) the polyherbal formulation and VPA placebo group. The primary outcomes, including frequency, duration, and severity of MH attacks, were measured at baseline and weeks 4, 8, and 12. However, secondary outcomes, including the Headache Impact Test 6 (HIT-6) Questionnaire and Parkman's score, were evaluated at baseline and end of treatment. The frequency, duration, and severity of migraine (P < 0.001 for all cases), HIT-6 (P < 0.001 for all cases), and FD (P < 0.001 for all cases) scores at the end of treatment showed a significant decrease in the 3 groups compared to the baseline. However, the differences in those variables between the 3 groups were not significant at the end of the study. The polyherbal formulation alone may improve the symptoms of migraine patients and other groups. This effect could be due to improving digestion and FD in migraine patients. [ABSTRACT FROM AUTHOR]

Despite the considerably high prevalence of cutaneous warts, no optimally effective and safe treatment is available. Leaves of date palm (Phoenix dactylifera L.; Arecaceae) have long been used in Iran's folk medicine as a remedy for warts. To assess the state‐of‐the‐art evidence on using P. dactylifera L. for warts, we conducted a systematic review using CINAHL (via EBSCO), Embase, Medline (via PubMed), ProQuest, Scopus, and Web of Science. We conducted an open‐label uncontrolled pilot clinical study to evaluate the efficacy and safety of a proprietary topical date palm leaf‐based ointment for the treatment of various types of nongenital warts. This study consisted of an 8‐week treatment phase and a 4‐week follow‐up phase. The assessed outcomes included complete clearance, patient satisfaction (on Likert scale), and the occurrence of any adverse effect. The systematic review demonstrated that the effects of date palm on warts have not been scientifically studied. Thirty patients entered the study with a mean age of 29.5 years (SD = 14.04); among which 17 were female and 13 were male. The patients presented diverse types of warts: verruca vulgaris 15 (50%), plantar 9 (30%), plane 2 (7%), periungual 2 (7%), and warts at multiple sites 2 (7%). In this trial, 19 patients (63.3%) experienced complete clearance and 5 patients (16.6%) experienced partial clearance. Eight patients (26.67%) dropped out during the study. 21 (70%) patients were very satisfied (score on Likert scale = 5) while 1 (3.3%) patient with partial clearance was somewhat satisfied (score on Likert scale = 4). No adverse effect was observed. The results of this pilot study indicate that the date palm leaf‐based ointment is a promising treatment whose efficacy and safety should be further investigated in a randomized controlled clinical trial. [ABSTRACT FROM AUTHOR]

Objectives: Radiotherapy is one of the treatments used for different types of cancer. Acute radiodermatitis is one of its most common complications. Despite the high prevalence of radiodermatitis, few studies investigated how to prevent or treat this complication. Hence, a standard treatment has not been introduced so far. We sought to evaluate the efficacy of Dermolina-Henna cream, a new polyherbal formulation, compared to Mometasone cream for alleviating acute radiodermatitis among breast cancer patients. Design: Randomized active-control double-blind clinical trial. Setting/Location: The oncology clinic of Shohaday-e Tajrish Hospital (Tehran, Iran). Subjects: Women older than 18 years with breast cancer undergoing radiotherapy. Interventions: Patients were instructed to apply a thin layer of Dermolina-Henna or Mometasone cream once daily on their lesions at least 3 h after radiotherapy for 4 weeks, and if grade I or II radiodermatitis developed, also afterward. Patients were visited weekly until end of study at after 4 weeks. Radiation Therapy Oncology Group standard questionnaires were evaluated and recorded every week as the primary outcome. Outcome measures: Primary outcome was defined as evaluating the efficacy of Dermolina-Henna cream to change the radiodermatitis grade, while the level of patients' satisfaction and the rate of adverse events recorded by patients were secondary outcomes. Results: The trends on decrease in number of lesions, erythema, radiodermatitis grade, burning sensation, pain, and itchiness were statistically significant for each treatment, separately (p < 0.001), except for radiodermatitis grade in Mometasone group (p = 0.4). Dermolina-Henna was significantly better than Mometasone in alleviating burning sensation (p < 0.001) and itchiness (p = 0.041). Approximately 3.7% of patients showed adverse events and 3.7% declared dissatisfaction in both groups. Conclusions: In summary, we showed that Dermolina-Henna cream and Mometasone cream were significantly effective in decreasing severity of radiodermatitis symptoms among patients with breast cancer. Dermolina-Henna cream was significantly superior to Mometasone cream in alleviating burning and itchiness. Clinical Trial Registration Number: IRCT20200115046144N1. [ABSTRACT FROM AUTHOR]

Objective: For a long time, natural compounds have been used to accelerate wound healing. In this study, the topical effects of ammoniacum gum extract on wound healing were investigated in white male rats. Method: Following skin wound induction in aseptic conditions, 48 Wistar rats were divided into six equal groups; phenytoin cream 1% (standard), untreated (control), Eucerin (control), and 5%, 10% and 20% ointments of Dorema ammoniacum gum extract (treatment groups). All experimental groups received topical drugs daily for 14 days. The percentage of wound healing, hydroxyproline content, histological parameters, and growth factors (endothelial growth factor (EGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and transforming growth factor (TGF)-α) were measured in experimental groups. Results: The areas of the wounds in the treatment groups were significantly decreased compared with the wound areas of control groups at 5, 7 and 10 days after wounding. On the 12th day, the wounds in the treatment groups were completely healed. Hydroxyproline contents were significantly increased in the treatment groups compared with the control groups (p<0.001). In histological evaluation, the re-epithelialisation, increasing thickness of the epithelial layer, granulation tissue and neovascularisation parameters in the treatment groups showed significant increases compared with the control groups. Also, serum levels of TGF-β, PDGF, EGF and VEGF in the treatment groups were significantly increased compared to the control groups. Conclusion: The topical application of ammoniacum gum extract significantly increases the percentage of wound healing in rats and reduces the time of wound closure. [ABSTRACT FROM AUTHOR]

Rydingia michauxii and R. persica, respectively, known as Kase Gol and Goldar in Persian, belong to the family Lamiaceae and they are well known herbal medicine in Iran for the treatment of various diseases, particularly diabetes. This review aims to appraise the phytochemistry, ethnopharmacology, and pharmacological activities of Rydingia species growing in Iran and assess their potential in clinical applications. Besides, it critically evaluates existing literature and looks into the perspective for further research and utilization. All available scientific literature was consulted using the database searches involving Google Scholar, PubMed, and Web of Science applying the keyword Rydingia and its Syn; Otostegia. Only the search results that are associated with the Iranian species R. michauxii and R. persica are included in this review. α-pinene, carvacrol, caryophyllene oxide, diisooctyl phthalate, dillapiole, eugenol, hexadecanoic acid, and pentacosane are the major constituents of the essential oils of the Rydingia species. Additionally, these species produce bioactive flavonoids, phenolic acids, steroids, and terpenoids. Extracts and active compounds from Rydingia species have been reported to possess various pharmacological activities including antidiabetic, anti-inflammatory, antimalarial, antimicrobial, antioxidant, cytotoxic, and lipid-lowering properties. Based on the information available to date on the Iranian Rydingia species, it will be worth subjecting these species to further developmental work involving preclinical and clinical trials. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Complementary and Integrative Medicine (CIM) is often taken up by individuals seeking relief from different diseases. This study investigates the prevalence and associated factors of CIM use in patients with COVID-19. Methods: In this telephone-based, cross-sectional study, data on CIM usage were collected from COVID-19 patients from February till June 2020 in Fars province, Iran using a researcher-made checklist. Additionally, we asked about the patients' attitudes toward these treatments. Results: Out of 453 patients diagnosed with COVID-19, 400 (88.30%) responded to our calls and agreed to participate in the study. Among them, 276 patients reported using CIM to treat COVID-19 [prevalence: 69% (95% CI: 64.2 to 73.5)]. The most frequently used herbal medicine among COVID-19 patients was ginger (n = 273, 98.9%), thyme (n = 263, 95.3%), and black cumin (n = 205, 74.3%). Most of these patients were recommended to use herbal medicine by their families and friends (n = 96, 34.8%). Univariable logistic regression revealed that age under 50 years old, residency in urban areas (including the capital of the province and small cities), employment, academic education, and being an outpatient were statistically significant factors resulting in CIM usage. Multivariable logistic regression revealed that CIM use among outpatients was 3.65 times more than among inpatients. In addition, patients under 50 years old used CIM 85% more than older patients. Ultimately, only 9 (3.3%) patients consulted with their doctors regarding these medications. No side effects due to CIM use were reported. Conclusion: Many patients with COVID-19 used CIM, but few consulted with their physicians in this regard. Therefore, physicians should ask their patients about CIM usage, and patients should also report their use of CIM therapies during their medical visits. Furthermore, age and hospitalization status affected CIM use among patients with COVID-19. [ABSTRACT FROM AUTHOR]

Traditional Chinese medicine (TCM) includes over ten thousand herbal medicines, some of which were introduced from outside countries and territories. The Silk Road enabled the exchange of merchandise such as teas, silks, carpets, and medicines between the East and West of the Eurasia continent. During this time, the 'Compendium of Materia Medica' (CMM) was composed by a traditional medicine practitioner, Shizhen Li (1,518-1,593) of the Ming Dynasty. This epoch-making masterpiece collected knowledge of traditional medical materials and treatments in China from the 16th century and before in utmost detail, including the origin where a material was obtained. Of 1892 medical materials from the CMM, 46 came from Persia (now Iran). In this study, the basic information of these 46 materials, including the time of introduction, the medicinal value in TCM theory, together with the current status of these medicines in China and Iran, are summarized. It is found that 20 herbs and four stones out of the 46 materials are registered as medicinal materials in the latest China Pharmacopoeia. Now most of these herbs and stones are distributed in China or replacements are available but saffron, ferula, myrrh, and olibanum are still highly dependent on imports. This study may contribute to the further development, exchange, and internationalization of traditional medicine of various backgrounds in the world, given the barriers of transportation and language are largely eased in nowadays. [ABSTRACT FROM AUTHOR]

Purpose: Chronic rhinosinusitis (CRS) is a frequent respiratory disease. As self-medication is a common issue in the world, this study aimed to estimate its frequency in patients with CRS. Methods: 144 CRS patients referred to a university hospital, were evaluated for self-medication, included type, duration, frequency, and its causes, their SNOT-22 questionnaire and Lund–MacKay scores. The data were analyzed using SPSS v.21 and the level of significance was considered as P ≥ 0.05. Results: 30.6% of the cases used self-medication (65.9% used chemical drugs and 63.6% used herbal drugs), not associated with their age, gender, educational or economic level. The most common chemical drugs were antibiotics, analgesics and decongestants (75.9%, 55.2% and 10.3%, respectively) and the most common non-pharmaceutical agents included steam inhalation and herbal infusions (71.4%). The efficacy of self-medication was rated as "none" to "little" in 54.64% of cases. The mean SNOT-22 score was 59.54 ± 10.93 and 73.27 ± 8.12 in cases without and with self-medication (P = 0.034), and the mean Lund–MacKay score was 11.8 ± 5.3 and 17.2 ± 4.3 in cases without and with self-medication, respectively (P = 0.002). The top reasons for self-medication were "considering the disease unimportant" and believing chemical drugs being "harmful", "expensive", or "non-effective". Most patients who used self-medication did "not" advise it to others (80%). Conclusion: The high rate of self-medication in CRS patients calls for greater attention to this issue in these patients. It seems that self-medication is significantly associated with more severe grades of disease and lower QOL in CRS cases. [ABSTRACT FROM AUTHOR]

Asian scholars especially from Iran and China preserved most of the wisdom and knowledge of antiquity in their writing and they had great influence even on both European traditional and modern medical sciences. The current searching was done by the keywords in main indexing systems including PubMed/MEDLINE, Scopus and Institute for Scientific Information Web of Science as well as the search engine of Google Scholar. Avicenna famous book was Canon, which reviewed all medical knowledge studied by the ancient Greek and Muslim scientists. Avicenna has introduced many medicinal plants and herbs and its knowledge influenced by both Eastern and Western traditional science. Rhazes was a great Persian alchemist, musician, mathematician, philosopher and physician. Bian Que was one of the most famous medical man and physician in ancient China who attached particular importance to the changes in the pulse examination. He is known as the founder of traditional Chinese medicine, and his four diagnostic methods were inspection, smelling and listening, inquiry, and palpation. Hua Tuo, Zhang Zhongjing, and Ge Hong were eclectic philosophers who dedicated his life to searching for physical immortality and traditional Chinese medicine, which he thought was attainable through alchemy. Sun Simiao also valued sanitation, exercise and disease prevention. Li Shizhen, a famous Chinese scholar who compiled a highly influential material medica. It is recommended to survey on their rules in different majors with details in future studies to make a better connection between modern and historical medical science. [ABSTRACT FROM AUTHOR]

Background: Nonalcoholic fatty liver is the most common chronic liver disease. Regarding the side effects of synthetic medicines and the variety of natural products in Iran climate, the present study aimed to investigate the effect of medicinal plants and natural products on liver enzymes in patients with non-alcoholic fatty liver disease in Iran using meta-analysis. Methods: To extract the intended studies, internal and external databases, including SID, Magiran, IranDoc, PubMed, Scopus, Web of Science, Embase, Cochrane, and Clinical Trial Registration System of Clinical trial.gov, the ISRCTN system, as well as Clinical Trial Registration System affiliated to the World Health Organization were searched. The obtained data were analyzed in STATA.14 software. A P value less than 0.05 was considered statistically significant. Results: A total of 44 rstudies were reviewed with a sample size of 1298 participant; they were published in the period from 2009 to 2018, silymarin had the highest effect on the reduction of AST (SMD = -2.68), cinnamon excreted the most profound effect on ALT (SMD = -2.69). In addition, cinnamon had the highest effect on gamma-glutamyl transferase (GGT) (SMD:-3.17), and curcumin had the highest effect on alkaline phosphatase (ALP) (SMD = -1.88). In the lipid profile, the effect of medicinal herbs and natural products on lowering total cholesterol and LDL was statistically significant. In the glycemic profile, the effect of medicinal plants and natural products on the reduction of fasting blood sugar, insulin, and hemoglobin A1c levels was statistically significant. Conclusions: As evidenced by the obtained results, the highest effect of using natural products was observed in the reduction of GGT, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels, respectively; nonetheless, the effect of natural products on ALP reduction was not statistically significant. [ABSTRACT FROM AUTHOR]

The goal of this study is to evaluate the chemical compounds, the anti-bacterial/fungal activity, and the cytotoxicity of the essential oil of three species of lamiaceae in Iran. After the extraction of the essential oil implementing the hydrodistillation method, the analysis and identification of the compounds were carried out with a chromatograph coupled with a mass spectrometer. For the evaluation of the anti-bacterial/fungal activity of the essential oils, the measurement of the diameter of inhibition halo, the minimum inhibitory concentration (MIC), bactericidal and fungicidal concentrations (MBC/MFC) were utilized; and for the evaluation of the cytotoxic activity of the essential oils, the 3-(4,5-dimethylthiazolyl)-2,5-diphenyltetrazolium bromide (MTT) method was used. The results show that the dominant compounds in the Perovskia abrotanoides Kar essential oil were camphor (21.68%), 1,8-cineole (14.26%), and α-pinene (7.23%); moreover, the dominant compounds in the Salvia reuteriana Boiss. Essential oil were benzyl benzoate (27.10%), linalool (13.27%), and sclareol (7.75%); in addition, the dominant compounds in the Ziziphora clinopodioides subsp. rigida (Boiss.) Rech.f. were cyclofenchene (25.29%), pulegone (14.14%), and menthol (7.70%). The largest halo diameter of inhibition halo (~ 22 mm) was against Streptococcus pyogenes and the strongest inhibiting and killing activity was against Candida albicans (MIC and MFC = 125 μg/mL) shown by the S. reuteriana essential oil which, respectively, matched the control antibiotics rifampin and nystatin. The analysis of the MTT test results showed that the Z. clinopodioides subsp. rigida essential oil (with IC50 value of ~ 144.2500) had the strongest cytotoxic activity against human ovarian cancer cells (OVCAR-3). On the whole, the results show that the essential oil of the Lamiaceae family plants is a source for various compounds with potential biological activities which can serve as a possible alternative to produce herbal medicine which are effective on some microorganisms and cancer cell lines. [ABSTRACT FROM AUTHOR]

Background: The use of complementary and alternative medicine (CAM) therapies has increased in recent years throughout the world and in Iran. Nonetheless, there are limited data about the prevalence of their use. This study aimed to assess the prevalence of using CAM therapies among patients with pressure ulcer (PU). Methods: This cross-sectional study was conducted in 2019–2020. Participants were 299 patients with PU conveniently selected from wound clinics and healthcare settings in Shiraz, Iran. A demographic questionnaire and the International Questionnaire to Measure Use of CAM were used for data collection. The data were analyzed using the SPSS software (v. 22.0). Results: All 299 participants completed the study. Their mean age was 59.56 ± 18.76 years. The most common CAM therapies used for PU management were herbal products (100%), vitamin supplementation therapy (45.2%), spiritual therapies (21.7%), wet cupping therapy (16.4%), leech therapy (9.4%), acupuncture (1.7%), dry cupping therapy (1.3%), and massage therapy (1.3%). The most common herbal product used for PU management was Pistacia atlantica gum either alone or in combination with other herbal products (15.5%). The use of CAM therapies had significant relationship with participants' age, underlying conditions, and PU stage (P < 0.05) and the most significant predictor of using herbal products for PU was educational level (P < 0.05, OR = 5.098). Conclusions: The use of CAM therapies, particularly herbal products, for PU management is high in Iran. Quality public education and close professional supervision are needed for the safe use of these products. [ABSTRACT FROM AUTHOR]

Objective: Infertility has a significant impact on the sexual function of couples. The use of herbal medicine has been highly important throughout the history of medicine. The present study was conducted to evaluate the effect of date palm on sexual function of infertile couples. Results: The present study was a double-blind, placebo-controlled clinical trial conducted on infertile women and their husbands who referred to infertility clinics in Iran in 2019. The intervention group was given a palm date capsule and the control group was given a placebo. Data were collected through female sexual function index and International Index of Erectile Function. The total score of sexual function of females in the intervention group increased significantly from 21.06 ± 2.58 to 27.31 ± 2.59 (P < 0.0001). Also, other areas of sexual function in females (arousal, orgasm, lubrication, pain during intercourse, satisfaction) in the intervention group showed a significant increase compared to females in the control group, which was statistically significant (P < 0.0001). All areas of male sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction) significantly increased in the intervention group compared to the control group (P < 0.0001). The present study revealed that 1-month consumption of date palm has a positive impact on the sexual function of infertile couples. Trial registration The trial was retrospectively registered in the Iranian registry of clinical trials at 2020-10-07 (https://www.irct.ir/trial/51339; registration number: IRCT20200925048834N1) [ABSTRACT FROM AUTHOR]

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Objectives: Breastfeeding is highly important for a child's health, and the widespread use of herbal medicines as galactagogues has been reported. The present study was conducted to evaluate the use of traditional, complementary, and integrative medicine (TCIM) and its determinants among breastfeeding mothers in Shiraz, Iran. Design: Cross-sectional study. Setting/Location: Neonatal clinics affiliated to Shiraz University of Medical Sciences. Subjects: Mothers elder than 18 years old. Interventions: Nothing. Outcome Measures: Prevalence and of the use of TCIM products and its associated factors. Methods: In this cross-sectional study, mothers older than 18 years who referred to neonatal clinics affiliated to Shiraz University of Medical Sciences were enrolled. Using a structured interview, the authors explored the prevalence and of the use of TCIM products and its associated factors. Results: Of 625 mothers who were approached, 483 agreed to participate (response rate: 77.3%). The average age was 27.3 ± 5.9 years. The prevalence of using TCIM products during current breastfeeding was 97.1%. There were 168 working mothers (44.9%); 163 mothers (34.1%) complaining of postpartum breastfeeding problems, and 327 mothers (68%) had no history of breastfeeding. Recommendations of medical staff or relatives were the most frequent reasons for the consumption of TCIM products (64.9%). Only 27% of mothers disclosed the use of TCIM products to their doctor or health care provider, although 62% of mothers were asked about the use of such products. Notably, 438 mothers (95.8%) considered TCIM to increase their milk. Based on multivariable logistic regression, literacy and past use of TCIM galactagogues were independently associated with TCIM products use. Conclusions: The use of TCIM galactagogues is highly common among breastfeeding mothers in south of Iran, showing a diverse range of determinants. It is necessary to evaluate the safety and efficacy of common herbal galactagogues, and evidence-based studies must be designed to achieve standardized complementary medicine approaches in this regard. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the prevalence and patterns of complementary and alternative medicine (CAM) usage amongst multiple sclerosis (MS) patients in Iran and to evaluate the perceived effectiveness. Methods: This was a descriptive cross-sectional study. Data were collected from 194 patients with MS at the neurology clinics affiliated with Shiraz University of Medical Sciences by a semi-structured questionnaire. Results: The prevalence of CAM usage was 67.9%. Herbal medicine was the most common CAM used among the patients (64.2%). Cupping therapy, relaxation therapies, acupuncture, leech therapy were the other common CAM modalities used. Although less commonly used, yoga had the highest perceived effectiveness. Conclusions: Due to the high prevalence of CAM usage, physicians should inform their patients about the advantages and disadvantages of CAM so as to help the patients make an informed choice. [ABSTRACT FROM AUTHOR]

■ cis and trans spiroethers levels were studied in different parts Arnebia species. ■ Samples assayed by High Performance Liquid Chromatography (HPLC-PAD-MS). ■ Heatmap analysis showed chemical diversity among the species. ■ A. euchroma showed the most anti-cancer activity against HepG2. Spiroethers comprise a sub-class of spirocycles and exert various biological properties such as antibacterial and anti-tumor activities. The present study investigated the total spiroether isomers present in methanolic extract of root and aerial parts of 40 Arnebia species collected from 20 different geographical zones in Iran. Also, the cytotoxic effects of the methanolic extract of the samples and the retrieved isomers were assessed against eight cancerous and one non-cancerous cell-lines. In all Arnebia samples tested, two spiroether isomers namely, cis -(E)- and trans -(Z)-spiroethers were found and it was observed that root and aerial parts of Arnebia euchroma had significantly high levels of the two isomers as determined by High Performance Liquid Chromatography coupled with Photodiode Array Detection-Mass Spectrometry (HPLC-PAD-MS). Both isolated compounds, particularly cis -(E)-spiroether, could inhibit cancer cells proliferation while had little destructive effects in normal cells. Cis -(E)- and trans -(Z)-spiroethers inhibited HepG2 cell line proliferation with IC 50 values of 3.23 ± 0.24 and 4.80 ± 0.15 µg/mL, respectively. Among the samples extracts, aerial parts and root extracts of A. euchroma had the highest anti-cancer activity against HepG2 with IC 50 values of 6.32 ± 0.23 and 7.50 ± 0.11 µg/mL, respectively. The present study showed variations in cytotoxic activity of cis -(E)- and trans -(Z)-spiroethers among Arnebia species. [ABSTRACT FROM AUTHOR]

Background: Postpartum pain contributes to increased irritability and excessive stress in the mother and consequently may inhibit successful breastfeeding, reduce a mother's ability to take care of her baby, and cause an imperfect mother-baby interaction. Evidence suggests the positive effect of ginger on reduction in uterus-associated pain. The objective of this study is to investigate the effect of ginger capsules on postpartum pain. Materials and Methods: The present double-blinded, randomized, placebo-controlled trial was conducted in Mahdiyeh Educational Hospital, Tehran. One hundred and twenty-eight mothers having moderate-to-severe pain following vaginal delivery were included. The participants were divided into two groups (A and B). Interventions were performed every 8 h in 24 h. In the first intervention (2 h after the delivery), Group A received 500 mg of placebo capsules (containing chickpea flour) and Group B received 500 mg of Zintoma (ginger rhizome) capsules. In the second and third interventions, Group A received 250 mg placebo capsules and Group B received 250 mg Zintoma capsules. All participants received 250 mg capsules of mefenamic acid in each intervention in addition to ginger or placebo capsules. The pain severity was measured before and half an hour, an hour, and 2 h after each intervention. Statistical analysis was performed using the SPSS software version. 22. The Chi-square, Fisher's, and t tests and the GEE model were applied to assess the pain severity. Results: The average pain severity was not statistically significant between the groups in the beginning of the intervention (P = 0.623). The mean score of pain significantly decreased within the duration of intervention in both groups (P < 0.001); however, the pain severity was significantly lower in the intervention group as compared to the control group at any point after the intervention (P = 0.006). Conclusion: Ginger can be used as an effective remedy for postpartum pain relief. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcer is one of the most devastating complications of uncontrolled diabetes. Although there have been advances in the management of diabetic foot ulcers, still diabetic foot ulcers are a major cause of many amputations in diabetic patients. Teucrium polium ( T. polium ) is widely used by folk medicine practitioners in Iran for the treatment of diabetic ulcers.The present study was designed to evaluate the safety and efficacy of topical T. polium ointment besides the standard treatment in diabetic foot ulcers.A total of 70 diabetic patients with foot ulcers grade 1 or 2 according to Wagner's scale were enrolled in this study. Patients were randomly divided into two groups. Patients in both groups received standard treatment for diabetic foot ulcers. In addition, group 1 received topical T. polium ointment, and group 2 received topical placebo ointment for 4 weeks. The T. polium and placebo ointments were rubbed twice daily two hours before the conventional dressing. The ulcer size, healing time, and laboratory tests were measured in both groups at baseline and end of the study after 4 weeks.Twenty-nine patients remained in the T. polium group and 26 in the placebo group until the end of the study. The mean surface area of ulcers was 3.52 ± 1.47 and 3.21 ± 1.67 cm 2 in T. polium group and placebo group respectively at baseline which decrease to .717 ± .19 and 1.63 ± .72 cm 2 respectively at the endpoint. The mean ulcer surface area was significantly lower in T. polium compared with the placebo group ( p  < .0001) at end of the study. Also, the number of patients that completely recovered in the T. polium group was significantly higher than the placebo group ( p  < .001) at the end of the study.The addition of topical T. polium ointment to standard treatment significantly improves the healing time of diabetic non-infected foot ulcers., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The present study aims to investigate the knowledge, attitude, and performance of Iranian Healthcare Professionals (HP) about Complementary and Alternative Medicine (CAM) modalities. Methods: This cross-sectional study was carried out on 210 HP in 2019. Samples were selected from healthcare centers, clinics, and hospitals using census sampling. Data collection tools included demographic information, attitude, knowledge, and the amount of use of CAM modalities. Data analysis was performed using SPSS ver. 24. Results: In this study, the response rate was 85.3% (n=209). A majority of respondents had a positive attitude toward CAM (n=166, 79%), but their level of knowledge was limited (n=154, 73.6%). The most commonly used CAM modalities were herbal medicine (93.2%), exercise therapy (75.4%), and hydrotherapy (75.2%), respectively, and the least commonly used ones were magnetic therapy (2.9%) and hypnosis (4.8%). The most important reasons for the use of CAM modalities by HP included fewer side effects than medical treatments (57.4%), its lowest cost than medical treatments (34.9%), non-serious disease with no need for referral to a clinic (32.1%), and its more convenient access than medical treatments (30.6%). The results showed that there was a significant relationship between the education level and the use of CAM modalities (p<0.05). There was also a significant relationship between the suggestion of CAM modalities and the amount of use of these modalities, and those who used these modalities would also have recommended them to their clients more frequently (p<0.05). Conclusion: The results showed that most of HP used at least one of the CAM modalities and had a positive attitude towards CAM. As the level of knowledge was limited, training courses should be implemented to increase health practitioner's level of knowledge on CAM. [ABSTRACT FROM AUTHOR]

Background: The incidence of application of medicinal herbs during pregnancy has increased significantly among women over the past years; however, the safety and efficacy of medicinal herbs during pregnancy are still unclear. The aim of the present study was to categorize the predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior (TPB). Methods: The present descriptive-analytical study was conducted on 300 pregnant women referred to Kashan health center to receive prenatal care services in 2020. The study participants were randomly selected using stratified random sampling with proportional allocation. The data collection tool was a two-part researcher made questionnaire. The first part of the questionnaire included demographic information, midwifery information, and questions related to women's awareness about herbal medicine. The second part of the questionnaire was designed based on the theory of planned behavior including attitudes, perceived behavioral control, subjective norms, intention, and behavior performance. Data were analyzed using descriptive statistics, regression analysis, and SPSS version 18.0. Results: The mean age of participants was 28. 7±5.4 years (range, 15–45 years), the majority were housewives (88.3%) and had secondary education (39.3%). A total of 164 women (57. 1%) used medicinal herbs during pregnancy. The individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with behavioral intention (P < 0.05). Similarly, subjective norms were the most predictor of using herbal medicine among pregnant women (P < 0.05). Conclusion: The findings revealed that more than 50 % of pregnant women used medicinal herbs during pregnancy. The present study showed that the individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with intention of herbal medicine use among pregnant women. Likewise, subjective norms were the most predictor of herbal medicine use among pregnant women. The TPB should be addressed in planning health education programs and modifying health behaviors, including self-medication, especially during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: The present study was conducted to evaluate the prevalence of trend and use of complementary and alternative medicine in patients referring to the Gastroenterology clinics in Mashhad. Methods: The present cross-sectional study was performed at Gastroenterology clinics affiliated with Mashhad University of Medical Sciences. The study began in December 2015 and ended in March 2017. The study subjects (n=751) were randomly selected from patients referring to Gastroenterology clinics in the city of Mashhad. Patients responded to the questions through interviews. The collected data were analyzed by SPSS-16 statistical software. Results: This study was conducted on 751 patients referring to gastroenterologists; of whom, 274 (48.36%) were male and 476 (38.63) were female. According to the results, the most popular complementary and alternative medicine treatments were respectively herbal medicine, cupping therapy and acupuncture. A significant difference was observed in the means at is faction with complementary and alternative medicine between those who believed in it and those who did not (p=0.001); but, no significant difference was detected in mean satisfaction with complementary and alternative medicine between patients with different occupations (p=0.193). There was also a significant difference in the number of patients between the group of patients receiving chemical medication and the group of patients receiving complementary and alternative medicine therapies (p=0.005). No significant difference was found in the level of satisfaction with complementary and alternative medicine between participants referring to the Gastroenterology clinics for different causes (p=0.431); nonetheless, the highest satisfaction was observed in patients with malignancy, and the lowest satisfaction was detected in patients with esophageal disorders. Conclusion: This study indicated the high prevalence of complementary and alternative medicine in Iran. The worldwide popularity of complementary and alternative medicine should not be overlooked, therefore; current medical treatment systems need to be revised and modified. [ABSTRACT FROM AUTHOR]

Herbal medicines have been reported to contain many contaminants that are potential harmful to health. These include heavy metals, such as lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg). Therefore, this study aimed to measure the levels of Pb, Cd, As, and Hg in several orally administered herbal products available in the Iranian market. Fifteen products labeled (A-O) of different brands from three different production batches (n = 45) were purchased from traditional herbal medicine factories in Iran. Each sample was digested with nitric acid by the wet digestion method, and the resultant solutions were used to determine the concentrations of Pb, Cd, As, and Hg. These measurements were performed using flame atomic absorption spectrometry, graphite furnace atomic absorption, or cold vapor atomic absorption. The lead, cadmium, arsenic, and mercury contents in the investigated samples did not show significant levels that may be associated with toxicity. All four metals were present at concentrations below the limits recommended by the WHO (World Health Organization), American Herbal Products Association (AHPA), and Canadian standard, but in several herbal products, the concentrations of these trace elements exceeded the Agency for Toxic Substances and Disease Registry (ATSDR). The concentrations of Pb, Cd, As, and Hg in commercially available herbal remedies were well below the acceptable intake recommended by global recommendations. Our findings revealed that at present, the amount of heavy metals in medicinal herbs processed at the level of supply by pharmacies licensed is favorable. [ABSTRACT FROM AUTHOR]

Introduction: Wound healing, which is caused by burns, diabetes, traumatic injury, as well as surgery, poses a serious health threat if left untreated. Case Report: The patient is an 18-year-old man with a complaint of injury to the last finger ring of the left hand and active bleeding from the site of the injury following work in a carpentry workshop, referred to the emergency department of Marvdasht Hospital. After referring to an orthopedic specialist and suggesting tissue repair in the operating room by the doctor, this patient refuses to continue treatment and tries to repair the damaged tissue by traditional methods. The compounds used by a person who masters the rules of traditional Iranian medicine are known as a comprehensive elixir and include a combination of saffron and honey to reduce infection, and a combination of cardamom, white fennel and ginger for healing and a combination of white pepper as a painkiller. Conclusion: The results of this study showed that the combination of herbs with a comprehensive elixir could heal the injury. Such wounds require the use of antibiotics due to the risk of osteomyelitis. Therefore, topical application of this herbal compound has shown both antibiotic and restorative properties. [ABSTRACT FROM AUTHOR]

Background: Punica granatum L. (pomegranate) with astringent activities and Matricaria chamomilla L. (chamomile) with anti-inflammatory and antioxidant properties are natural remedies used for various skin disorders, including wound healing. Objectives: This study was conducted to evaluate the individual and combined wound healing activity of the methanol extracts of pomegranate and chamomile flowers. Methods: After preparing the menthol fraction of pomegranate and chamomile flowers, the content of total phenols, total tannins, and total flavonoids of fractions was measured. For standardization of pomegranate and chamomile fractions, Gallic acid and apigenin-7-O-glucoside contents of them were determined using high-performance liquid chromatography (HPLC). Moreover, their antioxidant activities were examined using DPPH and FRAP tests. The antimicrobial assay was performed against Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa. Three different concentrations of methanol fraction of each plant and one combination dose of fractions were investigated for their wound healing activities in an excision wound model on the rats' dorsum. Finally, histopathological studies were done at the end of the experiment. Results: Phytochemical examinations showed high amounts of phenolic compounds in pomegranate flowers, while chamomile flower fractions contained a high amount of total flavonoids. Both fractions, especially pomegranate, had potent antioxidant activity. The best results for wound closure were observed 7 days after wound induction. All treated groups exhibited superior wound contraction compared to their placebo at all measurement times. The combined form of pomegranate and chamomile had better wound healing properties compared to a single therapy, especially on time earlier to wound induction. Conclusion: This study represented high antioxidant and wound healing activities for methanol fraction of pomegranate and chamomile flowers, which could be related to their high content of phytochemicals. In comparison with single herb treatment, the combined form of these two fractions in lower concentrations accelerated wound closure. [ABSTRACT FROM AUTHOR]

Conocarpus is a tree with two flowering species of Conocarpus lancifolius and Conocarpus erectus. It is commonly known as, it is commonly known as sycamore tree or white buttonwood mangrove in Iran. It durable and can withstand conditions such as extremely high temperatures, low drainage, pressurized soil, air pollution, and salty water. In the past, this tree was used to treat various diseases such as diabetes, conjunctivitis, gonorrhea, and other infectious diseases. Recent studies have shown the antidiabetic, anticancer, antimicrobial, and antioxidant properties of various parts of Conocarpus including leaves, bark, stem, and fruit in laboratory and animal models. In addition, conocarpus is a natural purifier and can be used to remove heavy metal contaminants and toxins from water, soil and air. As a biomarker, conocarpus can also be examined quantitatively and qualitatively for the amount of pollutants in different parts of the tree. To date, no scientific research has shown that conocarpus pollen is allergenic or immunogenic. In this botanological review article, the phytochemical and medicinal properties of this valuable tree in southern Iran was evaluated. [ABSTRACT FROM AUTHOR]