Seyde Sedighe Yousefi

Background: Chemotherapy-induced nausea and vomiting (CINV) are common among patients with breast cancer, even with standard antiemetic therapy. Given the limitations of existing treatments, there is increasing interest in complementary options with antioxidant, anti-inflammatory, and antispasmodic properties. Objectives: This study evaluated the effectiveness of pomegranate–mint (Vomigramint) syrup, used in addition to standard antiemetics, for reducing nausea severity and vomiting frequency during the anticipatory, acute, and delayed phases of CINV in women with breast cancer receiving moderately or highly emetogenic outpatient chemotherapy. Methods: In this double-blind, randomized, placebo-controlled trial, 66 women with breast cancer were enrolled. Eligible patients had experienced CINV during at least one previous chemotherapy cycle despite standard antiemetic regimens. Participants were randomized to receive either Vomigramint syrup or a matched placebo. Nausea severity and vomiting frequency were recorded daily. Results: Of 97 patients screened, 66 were randomized to receive Vomigramint syrup or placebo. Baseline characteristics were comparable between the groups, although delayed-phase nausea severity differed significantly at baseline. Compared with placebo, Vomigramint syrup significantly reduced nausea severity and vomiting frequency across the anticipatory, acute, and delayed phases of CINV. A greater proportion of patients in the Vomigramint group demonstrated clinical improvement, particularly during the delayed phase. No treatment-related serious adverse events were observed. Conclusions: These findings suggest that Vomigramint syrup may be a beneficial adjunct to standard antiemetic therapy for reducing nausea severity and vomiting frequency in patients with breast cancer who are receiving chemotherapy. Further well-designed randomized clinical trials using standardized herbal formulations are warranted to confirm these findings.

Context: Menorrhagia is an important healthcare challenge. Complementary and alternative medicine therapies are strategies with potential positive effects on menorrhagia. Objectives: The aim of this study was to systematically assess the effects of herbal products on menorrhagia. Methods: This was a systematic review and meta-analysis. PubMed, Scopus, Web of Science, Embase, Cochrane Library, Barekat Gostar, Scientific Information Database (SID), Magiran, and IranDoc international and Iranian databases, in addition to the Google Scholar search engine, were searched without any time or language limitation (updated until 02.07.2022). Eligible studies were combined through the random-effects model based on their sample sizes, mean scores, and standard deviations. Data analysis was performed at a significance level of less than 0.05 using STATA software (version 14.0). Results: Nineteen trials on 1715 women (856 and 859 subjects in the control and intervention groups, respectively) were reviewed. After the intervention, menstrual bleeding severity in the first, second, and third cycles (P < 0.001) and the number of menstrual days in the first (P < 0.001), second (P < 0.001), and third (P = 0.487) menstrual cycles significantly decreased in the herbal products group. There were no significant between-group differences regarding the bleeding severity at the pretest (P < 0.001) and in the third cycle (P < 0.001) and the number of menstrual days at the pretest (P = 0.131) and in the second (P < 0.001) and third cycles (P = 0.014). However, the bleeding severity in the intervention group was significantly less than the control group in the first (P < 0.001) and second cycles (P < 0.001), and the number of menstrual days in the intervention group was significantly less than the control group in the first cycle (P = 0.004). Conclusions: Herbal products are effective in significantly reducing bleeding severity and the number of menstrual days among women with menorrhagia, and their effects reduce over time.

Background: Leishmaniasis is a vector-borne zoonotic disease that remains as a major public health problem around the globe, with a higher burden in poor or developing countries. Pentavalent antimonials such as glucantime are currently being used as the first-line treatment for cutaneous form of leishmaniasis, but they are associated with significant side effects. Evidence suggests that extracts from different parts of Sambucus ebulus may have analgesic, anti-inflammatory and favorable skin healing effects. In this study, we investigated the potential therapeutic efficacy of S. ebulus fruit extract in treatment of cutaneous leishmaniasis.Methods: This was a randomized, double-blind, placebo controlled clinical trial that was carried out on 95 patients with confirmed cutaneous leishmaniasis. The subjects were assigned to an intervention and a control group. All patients received the standard treatment for leishmaniasis. In addition, the intervention group received a 5% ointment prepared from the methanolic extract of S. ebulus fruit, while the control group received a placebo. Healing rate and clinical characteristics of the lesions were assessed before the intervention and once weekly until complete epithelialization of the lesions (or up to 12 weeks).Results: The 5% topical ointment of S. ebulus fruit had no significant effect on healing probability, healing rate or treatment outcome, but it significantly reduced the lesion size.Conclusion: Combination therapy with pentavalent antimonials and the S. ebulus fruit ointment could significantly reduce the lesion size but has no effect on the treatment outcome.

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.

Context: Hypertension has been identified as the world’s third leading cause of death. Due to their cost-effectiveness and lack of adverse effects compared to antihypertensive medications, medicinal plants have gained popularity in most countries. The olive leaf is one of these plants. As a result, the purpose of the current systematic review and meta-analysis was to determine the effect of olive leaf consumption on systolic and diastolic blood pressure. Evidence acquisition: The following domestic and international databases were searched in order to retrieve relevant studies: PubMed, Scopus, Web of Science, Embase, Cochrane, ProQuest, and Google Scholar search engine, the ClinicalTrials.gov Protocol Registration and Results System (PRS), the ISRCTN registry administered by BioMed Central, and the World Health Organization’s (WHO) International Clinical Trials Registry Platform. The data collected were analyzed using STATA software (version14) at a significance level of P<0.05. Results: Olive leaf consumption had a significant effect on systolic blood pressure [-0.87 (95% CI: -1.09, -0.64)] and diastolic blood pressure [-0.39 (95% CI: -0.57, -0.21)] in five studies with a sample size of 145 people (mean age range of 33.30 ± 5.25 years). Consumption of olive leaves also decreased cholesterol levels [-0.52 (95% CI: -0.81, -0.22)], low-density lipoprotein (LDL-c) levels [-0.35 (95% CI: -0.58, -0.12)], and triglycerides levels [-0.67 (95% CI: -1.19, -0.16)]. Nonetheless, the olive leaf had no statistically significant effect on reducing highdensity lipoprotein levels. Conclusion: We observed that olive leaf consumption significantly reduced the levels of systolic and diastolic blood pressure, cholesterol, triglycerides, and LDL-c. Registration: The current protocol was also registered on PROSPERO (ID: 221277, Date: 16.04.2022).

Introduction: Green tea drinking is one of the traditional methods to prevent colorectal cancer (CRC). The present study proposes a systematic review and meta-analysis approach to investigate the relationship between green tea drinking and CRC risk. Materials and Methods: The literature survey has been carried out using the previously published studies in the Google Scholar search engine and various electronic databases, including Scopus, Cochrane, Web of Science, Embase, and PubMed. The review process has continued until July 13, 2021. Besides, the Q test and I2 index were employed to evaluate the heterogeneity of the studies. STATA 14 software has been conducted to analyze the gathered dataset. It is essential to note that the significance level for statistical tests was set to 5% (P value < 0.05). Results: The results of 18 studies accomplished on 44,992 patients aged 19-80 years have been used to compute the relative risk of green tea consumption in CRC (OR [odds ratio] = 0.99; 95% CI: 0.83-1.18), colon (OR=0.97; 95% CI: 0.85-1.10), and rectum (OR=1; 95% CI: 0.86-1.16). Although green tea consumption was a protective factor in Asia and the United States, it was considered a risk factor in Australia. The general population studies classified green tea as a risk factor for CRC, while hospital studies considered this product as a protective factor. Conclusion: The findings showed that green tea had the most significant effect on reducing the colon cancer risk, while it had the minimum influence on CRC. Additionally, it did not affect rectal cancer. It is essential to note that these relationships were not statistically significant. Registration: The current protocol was also registered on PROSPERO (#CRD42021276257, https://www.crd.york. ac.uk/prospero/display_record.php?ID=CRD42021276257).

Background: Today, hypertension is a significant public health problem globally, widely recognized as a major risk factor for death. Blood pressure-lowering herbal medicines and natural products have been used for centuries. The protocol aims to determine the effect of natural product use on blood pressure in Iran using data from previously published randomized controlled trials. The current protocol for a systematic review and meta-analysis is designed to determine the effect of natural product use on blood pressure in Iran. Methods: The protocol is developed using PICO (participants, interventions, comparisons, and outcomes) items to assess the effect of natural products on blood pressure reduction in randomized clinical trials (RCTs) in Iran. Specific MESH terms will be used to search Google Scholar, PubMed, and the Cochrane Central Register for randomized controlled clinical trials, as well as national databases such as Barekat Gostar, SID, Magiran, and IranDoc. The I2 index and the Q-test will be used to examine heterogeneity in the effect sizes of individual studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) of RCTs will be reported per Cochrane guidelines, and all forms will be based on validated Cochrane templates. Discussion: This protocol will detail the effects of natural products (interventions) in comparison to a placebo or other control group (comparators). Registration: The current protocol was also registered on PROSPERO (ID: CRD42021231837, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231837, Date: February 18, 2021).

For a long time, Melissa officinalis (M. officinalis) has been used to treat cardiovascular diseases. Therefore, this study aimed at evaluating the effects of M. officinalis on systolic and diastolic blood pressures in hypertensive patients. We conducted a double‐blind, controlled, randomized crossover clinical trial on 49 patients who received either M. officinalis capsules (400 mg/d; n = 23) or the placebo (n = 26) three times per day for a 4‐week period. After a 2‐week washout period, the M. officinalis group received placebo and the other group received M. officinalis for another 4‐week period. The systolic and diastolic blood pressures were measured once at baseline and then every 2 weeks for 10 weeks. The statistical analysis of the obtained data revealed that the chronology of the consumption of M. officinalis and placebo had no effect on the systolic and diastolic blood pressures in these two studied groups. Moreover, it was found that systolic and diastolic blood pressures significantly decreased after the consumption of M. officinalis, compared to placebo. Systolic and diastolic blood pressures in group A at the beginning of the study were 152.30 ± 5.312 mmHg and 95.52 ± 1.988 mmHg, respectively, and, after the first phase (drug use), reached 129.88 ± 9.009 mmHg and 80.13 ± 5.488 mmHg, respectively. Systolic and diastolic blood pressures in group B at the beginning of the study was 152.26 ± 5.640 mmHg and 94.44 ± 2.607 mmHg, respectively, and after the second phase (drug use), reached 131.77 ± 8.091 mmHg and 81.46 ± 7.426 mmHg, (p = .005), respectively. Also, no significant side effects were observed during the study. According to the results, M. officinalis can reduce systolic and diastolic blood pressures of the patients with essential hypertension.

Pica is an eating disorder characterized by craving for nonfood items, such as dirt, clay, detergents, soap, stone, and paper. It occurs in children who start feeling the world with the oral cavity. The exact etiology of this disorder is still unknown; nonetheless, its treatment and prevalence vary according to patients' behavior and characteristics. We aim to present a case report of a patient with pica who was treated with Persian Traditional Medicine. This treatment was performed using four doses of 15 ml Punica granatum extract after every meal for 3 weeks while fasting before breakfast. The patient's appetite improve within 3 weeks, with remarkable improvement in pica symptoms. Punica granatum extract seems to be effective in controlling pica.

Osteoarthritis is the most common cause of disability and aging is the major risk factor. One of the low‐risk herbal medicines for reducing pain and inflammation in persian medicine is Pistacia atlantica gum. A triple‐blind placebo‐controlled clinical trial was performed in order to evaluate the efficacy of P. atlantica gum ointment on knee osteoarthritis in elderly people. A total of 60 patients were randomly allocated to two groups. The intervention group used 4% P. atlantica ointment and the control group used placebo, topically applied three times a day, for 8 weeks. The patients were evaluated before and after the intervention using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. There were significant differences (p < .001) between two the groups in terms of joint stiffness and pain as well as function. Within groups, regarding the effect size (EF) in joint stiffness was 2.82 and 0.74 in the Pistacia and placebo groups, respectively. Regarding pain, the effect size of the intervention and placebo groups were 3.90 and 0.99, respectively. In addition, regarding function, the effect size of the intervention and the placebo groups were 4.33 and 1.17, respectively. Therefore, it seems that topical P. atlantica is significantly better than the placebo in the old patients with knee osteoarthritis.