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December, 2021 - VOL. 27, NO. 12  December, 2021
Ayurvedic Management of Hyperprolactinemia Secondary to Pituitary Microadenoma: A Case Report
Hemavathi Shivapura Krishnarajabhatt, BAMS, MD (Ayu);  Anjaly Muraleedharan, BAMS, MS (Ayu);  Parvathy Unnikrishnan, BAMS, MS (Ayu)
Hyperprolactinemia is a relatively common diagnosis to be expected in an adolescent age group with chronic menstrual disturbances. The present case report documents the efficacy of Ayurvedic management in a 21-year-old female with secretory pituitary microadenoma, which was found to be responsible for menstrual disturbances. The patient, with high prolactin levels with pituitary microadenoma, was subjected to an Ayurvedic management protocol, including Shamana nasya for 7 days followed by Shamana Cikitsa for 3 months. Patient follow-up was 6 months in duration. The clinical presentation of this case points towards the diagnosis of Asrgdara in Ayurveda. This is the first such case documented where Ayurveda was used as the intervention in a case of pituitary microadenoma with hyperprolactinemia, resulting in the complete absence of microadenoma and normalization of the prolactin level.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Impact of Yoga on Mental Health and Sleep Quality Among Mothers of Children With Intellectual Disability
Ashish Gupta, MD;  Satyapriya Maharana, MSc, PhD;  Kashinath G Metri, MD, PhD;  HR Nagendra, ME;  Karpakam Ullas, MSc
Objectives • Caring for a child with Intellectual Disability Disorder (IDD) is a tremendously stressful task for any mother, leading to poor mental health and compromised quality of life. Anxiety, depression, stress, and poor sleep quality are frequently observed in mothers with Intellectual Disability Disorder child. This study assessed the impact of a 1-month yoga intervention on anxiety, depression, stress and sleep quality in mothers of children with intellectual disabilities. Methods • We selected 53 mothers of children with intellectual disabilities between the age of 30 and 50 years (mean age, 40.2 ± 7.1 years). Of these mothers, 28 received 1.5 hours of integrated yoga practice consisting of physical postures, breathing techniques, relaxation techniques and meditation every other day for 1 month. The remaining 25 mothers, who served as the control group, participated in a group discussion session twice a week for 1 month. Main outcome measures • All mothers were assessed for anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), stress with the Perceived Stress Scale (PSS), and sleep quality with the Pittsburgh Sleep Quality Index (PSQI) at baseline and at 1 month. Results • Significant improvements in anxiety (-24.8%; P < .001), depression (-15.9%; P < .001), sleep quality (-25.1%; P < .05) and stress (-11.4%; P < .001) were observed after 1 month compared with baseline in the yoga group. In a similar fashion, a significant decrease in anxiety (-12.3%; P < .001), depression (-8.6%; P < .001) and sleep quality (-5.6%; P < .001) was seen in the control group as well. The between-group comparison of post-intervention scores revealed a significantly better improvement in anxiety (P < .001), depression (P < .001), perceived stress (P < .001) and sleep quality (P = .012) in the yoga group compared with the control group. Conclusions • Our study indicates that yoga can be used as an effective intervention to improve psychopathology and sleep quality in mothers of children with intellectual disabilities. We recommend future randomized controlled trials with larger sample sizes and of longer duration to study the long-term effects of yoga.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effects of Lycopene-enriched, Organic, Extra Virgin Olive Oil on Benign Prostatic Hyperplasia: A Pilot Study
Ángel Abengozar, MD;  Luis Blanco, Lic Sc;  Cristina Carrasco, PhD;  Ana Beatriz Rodríguez, PhD
Context • Epidemiological evidence has shown that lycopene consumption may be effective in both the prevention and treatment of various diseases, particularly prostate cancer. However, the influence of this dietary carotenoid on some of the most basic aspects of human health remains unknown. Objectives • The aim of the study was to determine the effects of consumption of a lycopene-enriched commercial product of organic, extra virgin olive oil (EVOO) on prostate health, sleep quality, antioxidant status, and anxiety. Design • The research team designed a pilot study with two intervention groups. Setting: The study took place in the city of Badajoz (Extremadura, Spain). Participants • Participants were 20 men aged =50, some of whom were healthy and some of whom had received a diagnosis of benign prostatic hyperplasia. Intervention: Participants were divided into a healthy-men (HM) group (n = 10) and a benign prostatic hyperplasia (BPH) group (n = 10). Both groups consumed 20 ml of lycopene (0.4 mg/ml) daily in a lycopene-enriched commercial product of organic extra virgin olive oil, at breakfast and/or lunch, for 30 days. Outcome Measures • Sleep quality, prostate markers—prostatic specific antigen and protein C reactive—and symptomatology, urine total antioxidant status, and emotional health were assessed at baseline and postintervention. Results • The level of prostatic specific antigen and symptomatology remarkably improved in men with benign prostatic hyperplasia, although the changes wasn’t statistically significant, and the total antioxidant status was significantly increased in healthy men (P < .05). Sleep quality in terms of nocturnal activity was significantly improved in both groups (P < .05). No adverse events were reported. Conclusion • The consumption of a lycopene-enriched, organic, EVOO positively influenced prostate health and other physiological variables. These findings may help to advance the development of new preventive and/or chemotherapeutic strategies based on lycopene.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Attitudes and Knowledge of Community Pharmacists Toward Complementary and Alternative Medicine: A Narrative Review
Kevin Clayton, BPharm;  Yoni Luxford, PhD;  Ieva Stupans, PhD
Context • The use of complementary and alternative medicine (CAM) in Australia is widespread, and self-treatment with CAM often occurs. Community pharmacies are a major supplier of CAM in Australia; consequently pharmacists may be approached by consumers in relation to self-treatment. Objectives • The study intended to appraise peer-reviewed literature regarding the supply of CAM in retail pharmacies and pharmacists’ knowledge and attitudes in relation to it. Design • The research team performed a narrative review of peer-reviewed studies published between January 1997 and December 2017. Four electronic databases—Web of Science, ScienceDirect, CINAHL, and PubMed—were systematically searched using keywords. A search strategy was devised using 4 keywords: knowledge and attitude, complementary and alternative medicine, stress, and pharmacist. English-language, full-text studies were sought, and the team considered only the results of studies conducted in Australia or in countries with similar healthcare systems. Setting • The study is a literature study. Results • Performance rankings were considered, with 10 studies being identified. Pharmacists were generally positive about CAM; however, they displayed a degree of uncertainty, particularly about efficacy and safety, that pointed toward a lack of confidence and a desire for better education. Knowledge, both self-rated and assessed, was lacking. Few studies explored the use of CAMs for specific physical-health conditions and fewer still addressed mental health. Conclusions • Pharmacists are ideally placed to interact with consumers and are often the first point of contact for those people wanting to self-treat. Pharmacists may lack the necessary practice knowledge and skills to appropriately advise consumers about CAM or about those conditions where self-treatment products fall predominantly into the CAM category, such as for stress.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Clam Extract Decreases Nasal Symptoms and Improves Sleep Quality after Septoturbinoplasty
Szu-Chi Chen, MD;  Chun-Yen Ke, PhD;  Ru-Ping Lee, RN, PhD;  Lieber Po-Hong Li, MD, PhD
Context • Nasal septal deviation (NSD) causes nasal blockage, which results in lower sleep quality among patients. A high percentage of patients still suffer from nasal symptoms as a result of the inflammatory response that occurs with septoturbinoplasty. Freshwater clams are a common food with an anti-inflammatory effect and have been used for promoting liver function for patients in China. Objectives • The study intended to evaluate the effects of clam extract (CE) in reducing inflammatory response, alleviating nasal blockage, and improving sleep quality for NSD patients after septoturbinoplasty. Design • The study was a randomized, controlled pilot that used a prospective design. Setting • The study took place at the Cheng Hsin General Hospital in Taipei, Taiwan. Participants • Participants were 52 patients with NSD at a clinic at the hospital. Intervention • Patients were randomly assigned to 2 groups: (1) an intervention group that received CE capsules and (2) a control group that received empty capsules that were identical in appearance to the CE capsules. Participants received the treatments 3 times a day for 2 weeks after septoturbinoplasty. Outcome Measures • Participants were assessed for nasal-symptom severity, wound inflammation, serum concentration of tumor necrosis factor alpha (TNF-a), and sleep quality. All outcome measures were undertaken at baseline, on various days during the study depending on the measure, and postintervention on day 14 for wound assessment and sleep quality. Results • After the septoturbinoplasty, the intervention group had lower nasal-symptom severity, wound inflammatory response, TNF-a concentration, and sleep disruption than those in the control group (P < .05). Conclusions • After septoturbinoplasty, CE can reduce nasal-symptom severity and inflammatory response and also improve patients‘ sleep quality. The anti-inflammatory effects of CE indicate that it can be considered to be an adjuvant therapy to improve sleep quality after surgery.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Feasibility of Yoga to Improve Symptoms in Individuals With Severe, Chronic Traumatic Brain Injury: A Mixed-Methods Case Series
Ileana Herrin, MS, OTR/L;  Amirah Pittman, MOT, OTR/L;  Pey-Shan Wen, PhD, OTR/L
Context • People with severe traumatic brain injury (TBI) experience lifelong sequelae that affect physical, cognitive, and mental health. In other populations, yoga has shown potential to alleviate insomnia, pain, and depression and to improve cognition. Objective • The study intended to investigate the feasibility of a six-week, group-yoga intervention for adults with severe chronic TBI, focusing on sleep, pain, mood, and executive function. Design • The research team performed a feasibility study using a mixed-methods, case-series design. Setting • The study recruited participants by distributing flyers to local communities and TBI support groups. Participants • Participants were two people with severe, chronic, TBI. Intervention • The intervention was a six-week course of group yoga, with 70-minute classes twice a week. Outcome Measures • The study assessed outcomes at baseline and postintervention using validated measures to assess executive function, mood, sleep, and pain: the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Neuropathic Pain Scale (NPS). A semistructured interview was conducted during the week postintervention to obtain qualitative data. Results • The study had a 100% retention rate, a 91.67% attendance rate, and high satisfaction. One participant demonstrated improvement in all outcomes, while the other showed mixed results. Depression showed the most consistent improvement, 47.2% on average. For insomnia, one participant showed improved sleep at 14.29%. The qualitative data demonstrated positive changes in cognition, mood, sleep, and pain. Conclusions • A six-week group yoga intervention is feasible and appears to be beneficial in alleviating symptoms, especially depression and insomnia, in people with severe chronic TBI. A longer intervention period was suggested by the participants.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Traditional, Complementary and Alternative Medicine in Dermatology: A Scientometric Literature Review
Engin Senel, MD
Introduction • Scientific literature lacks a scientometric analysis of traditional, complementary and alternative medicine (TCAM) for dermatology. The aim of this study is to investigate the associations between TCAM and dermatology as seen in academic literature published between 1975 and 2018. Methods • All materials analyzed in this study were collected from 3 major academic databases, namely Web of Science, PubMed and Scopus, and all documents assessed were published between 1975 and 2018. A keyword string of “dermatology” AND (“complementary medicine” OR “alternative medicine” OR “traditional medicine” OR “integrative medicine”) was used to search the databases. Results • A total of 316 articles were retrieved from Web of Science, 388 from Scopus and 389 from PubMed. Original articles represented 92.208% of all literature found. In addition, the USA had the highest number of publications with 61 documents, followed by the UK, China and Germany, while only three developing countries were represented in the group of most productive countries. Notably, low income countries were not represented in the list of countries with the highest volume of publications. Of all the institutions in the most represented countries, the University of Oxford was found to be the most productive. The most used keywords in the literature were noted to be “dermatology”, “alternative medicine”, “traditional medicine” and “psoriasis”. Conclusion • In view of the underrepresentation of low income developing countries in the productive group, it is suggested that researchers from these countries should be supported to produce novel TCAM studies in dermatology.
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December, 2021 - VOL. 27, NO. 12  December, 2021
The Effect of Oral Care with Black Mulberry Syrup on Oral Mucositis in Patients With COPD: A Mixed Study
Songül Karadag, RN, PhD;  Sevda Korkut Bayindir, RN, PhD;  Salih Levent Çinar, MD
Background • Oral mucositis often affects the quality of life of patients living with Chronic Obstructive Pulmonary Disease (COPD). Its symptoms include loss of oral mucous membranes, ulceration, bleeding and pain as well as bacterial, fungal and viral infections of the oral mucosa. Objectives • This study was carried out to investigate the effect of oral care with black mulberry syrup on oral mucositis healing in patients with COPD. Design • This mixed study was carried out in two stages– quantitative and qualitative. The quantitative stage was conducted as a randomized controlled experimental study while the qualitative stage was conducted by in-depth interview method. Setting • This study was conducted at the chest diseases clinic of a tertiary hospital in Turkey. Participants • The randomized controlled experimental study was completed with a total of 40 patients who had been diagnosed with COPD and oral mucositis between March 2017 and June 2018. They were divided into intervention and control groups consisting of 20 patients each. The qualitative study was conducted on 10 patients in the intervention group. Intervention • Patients in the intervention group gargled with 5 ml of black mulberry syrup for an average of 1 minute and swallowed it upon completion. They did this 3 times a day after meals for a period of 15 days after which they were interviewed. Outcome Measures • The quantitative data was collected using the Patient Information Form, Oral Evaluation Guideline, and WHO Oral Mucositis Scoring Index, while the qualitative data was collected using the in-depth interview form. Patients’ oral mucosa was assessed a total of 3 times during 3 interviews held on the first, seventh and fifteenth days of the study. Results • There was a significant decrease in scores of oral mucositis of the patients in the intervention group at the second and third follow-ups. Oral mucositis of the intervention and the control groups healed at an average of 9.1 ± 2.5 days and 12.1 ± 1.4 days, respectively. In addition, oral care with black mulberry syrup was found to alleviate mucositis-related symptoms. Conclusion • Oral care with black mulberry syrup accelerates mucositis healing and alleviates mucositis-related symptoms.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Relationship Between Attitudes about Medication Adherence and Complementary and Alternative Medicines in Elderly Individuals with Chronic Diseases
Betül Aktas, PhD, RN;  Ayse Berivan Bakan, PhD, RN
Background • The prevalence of chronic diseases increases in old age, and therefore, elderly individuals need to use a large number of medications. Primary Study Objective • This study was conducted to investigate the relationship between attitudes of elderly individuals with chronic disease toward medication adherence and complementary and alternative medicines. Methods/Design • This cross-sectional study was conducted between July and September 2018. The participants were 193 elderly individuals who were selected using the sampling method with a known target population. The study data were collected using Descriptive Characteristics Information Form, HCAMQ, and ARMS. Setting • The study was conducted in Family Health Centres in a city located in the eastern part of Turkey. Participants • The study involved elderly subjects who had been diagnosed with a chronic disease for at least 6 months that required continuous medication, and who could communicate sufficiently. Results • The mean ARMS score of elderly individuals was found to be 14.19 ± 3.01, showing moderate adherence to medications. The mean HCAMQ score of individuals was 25.93 ± 6.57, showing positive attitudes of individuals toward CAM. Further, a positive and statistically significant correlation was found between the total scores of ARMS and HCAMQ (P < .01). Conclusion • It can be suggested that elderly individuals endeavor to maintain medical therapies for their diseases, and they also have positive attitudes toward complementary and alternative treatments. These positive behaviors of the elderly should be supported. Also elderly individuals should be informed about how to take “complementary and alternative treatments” consciously, in a controlled and correct manner.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Time Series Forecasting of US COVID-19 Transmission
Yongmei Ding, PhD;  Rui Huang, MS;  Ningyi Shao, MBBS, PhD
Context • The increasing number of confirmed cases of COVID-19 globally is shocking every day. US daily deaths have numbered over one-thousand people per day for nearly 3 days (from November 18, 2020 to November 20, 2020), and total deaths have exceeded 250 000 as of November 21, 2020, which drives the medical community to search for trends to provide an early warning of rising numbers of cases and to prevent future increases. Objective • The study intended to evaluate available US COVID-19 data to determine the possibility of predicting the spread of COVID-19 in the USA. Design • The research team collected US COVID-19 data from a time-series view and established a seasonal autoregressive integrated moving average (SARIMA) model to predict trends. Results • According to the spatial and temporal distribution of cumulative confirmed cases, US COVID-19 cases are mainly concentrated in areas with high population density, with that variable having a positive correlation to the number of confirmed cases and deaths. The correlation coefficients are 0.95 and 0.817, respectively, indicating that the transmission of COVID-19 in the USA is characterized by agglomeration. After exploring the impact of population density, the research team established a SARIMA model to predict the trends, finding that US COVID-19 cases will continue to go up. Conclusions • By combining knowledge of the statistical features of the virus with modeling findings, the study determined a method that can improve understanding of the serious pandemic, paving the way toward the development of predictive and preventative solutions.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Acute Effects of Cold Pack for Different Periods on the Biomechanical Properties of the Rectus Femoris Muscle
Nuray Alaca, PhD;  Nilüfer Kablan, PhD
Context • Cold packs are silica gel packs that are commonly used in clinics. However, the packs are applied for various amounts of time, and the relationship between these times and temperature changes isn’t fully understood. Objectives: The study intended to investigate the acute effects of cold-pack application for different periods of time on the biomechanical properties of the rectus femoris muscle. Design • The study was randomized, controlled trial. Setting • The study took place at Acibadem Mehmet Ali Aydinlar University in Istanbul, Turkey. Participants • Participants were 60 healthy volunteers from the community, aged 18 to 23 years. Interventions • Participants were divided into four groups with n = 15 in each group. The cold packs were applied on the dominant rectus femoris muscle: (1) for 10 minutes in Group 1, (2) for 12 minutes in Group 2, (3) for 15 minutes in Group 3, and (4) for 20 minutes in Group 4. Outcome Measures • The outcome measures were the skin temperature, determined using a thermal camera, and biomechanical properties—tone and stiffness and muscle decrement—using a device that delivers a short mechanical impulse to the tissue. Outcomes were measured at baseline before the cold application, immediately post intervention after the cold application, and at 5, 10, 15, 20, and 30 minutes post intervention. Results • The mean skin temperatures were significantly lower in all groups compared to those before cold application (P < .05), and no significant differences existed between any of the groups (P > .05). Post intervention, while Groups 1 and 2 showed an increase in muscle tone and stiffness and a decrease in elasticity (P < .05), they began to approach their baseline state by the fifth and fifteenth minutes, respectively (P > .05). In Groups 3 and 4, the muscle stiffness increased at all time points (P < .05). Conclusions • The study showed that the rectus femoris muscle of healthy people becomes stiffer and less elastic as a result of cooling with cold packs that were applied for different time periods. The amount of cold-pack time that minimized the biomechanical corruption of the muscle and provides cooling was 10 minutes. Careful warming up is recommended before and after intense athletic performance, and caution in cooling the skeletal muscle should be exercised.
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December, 2021 - VOL. 27, NO. 12  December, 2021
A 3-Week Naturopathic Intervention Improves HbA1c, Weight, and Quality of Life Among Overweight and Obese Adults With Type 2 Diabetes: 6-Month Results From a Randomized Trial
Dieter Frisch, PhD;  Susanne Neuy, MD;  Angela Schuh, PhD;  Marita Stier-Jarmer, MA, MPH, PhD
Context • The “Oberstaufen Schrothkur,” a traditional naturopathic treatment, has been shown to lead to metabolic improvement in adults with type 2 diabetes. However, data concerning its benefits are still limited. Objective • The study aimed to investigate the effects of an Oberstaufen Schrothkur compared to a diabetes-friendly holiday in adults with type 2 diabetes. Design • The study was a single-center, 2-arm randomized controlled trial with 6-month follow-up. Setting • The interventions were carried out in the Oberstaufen health resort in Bavaria, Germany. Participants • Ninety-eight overweight or obese volunteers (mean age 61.5; 51% female) with type 2 diabetes received the randomly allocated intervention (Oberstaufen Schrothkur = 51; diabetes-friendly holiday = 47). Three participants were lost to follow-up. Intervention • The Oberstaufen Schrothkur included a low-calorie diet, daily changes between a higher or lower fluid intake, daily alternation in physical activities, and daily application of cold and damp body packs. The diabetes-friendly holiday included a holiday stay specifically tailored to diabetics. Outcome Measures • The primary outcome was change in hemoglobin A1c at 6 months post intervention. Secondary outcomes included body weight, body mass index, blood pressure, levels of cholesterol and triglycerides, well-being (WHO-5), and general health status (EQ-5D and SF-36). Results • Significant within-group improvements at 6 months were observed in both groups: sustained reductions in hemoglobin A1c (Oberstaufen Schrothkur: -0.67%; diabetes-friendly holiday: -0.55%) and weight reduction of 4.65% (-4.71 kg) in the Oberstaufen Schrothkur group and 3.91% (-3.95 kg) in the diabetes-friendly holiday group (P < .001), with no statistically significant difference between groups. The proportion of obese participants decreased by 13.8 (Oberstaufen Schrothkur) and 6.3 (diabetes-friendly holiday) percentage points. Compared to baseline, 80.4% (Oberstaufen Schrothkur) and 85.1% (diabetes-friendly holiday) of the participants reported no changes in hyperglycemia medication intake at 6 months. A medication decrease was observed in 9 (17.7%) participants in the Oberstaufen Schrothkur group and 6 (12.8%) participants in the diabetes-friendly holiday group. Conclusion • Adults with type 2 diabetes undergoing one of two 3-week interventions (Oberstaufen Schrothkur or diabetes-friendly holiday) had significant within-group improvements in glycemic control, weight reduction, blood pressure, well-being, and quality of life at 6 months while between-group differences did not reach significance.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effects of Supplementation with Lactobacillus Probiotics on Insomnia Treatment
Leandro dos Reis Lucena, MSc;  Helena Hachul, MD, PhD;  Carolina Leopoldino de Bortolli, BSc;  Monica Levy Andersen, PhD;  Vinicius Terra Loyola, MSc;  Sergio Tufik, MD, PhD
Context • According to the criteria of the International Classification of Sleep Disorders (ICSD-3), it is estimated that the prevalence of insomnia in the general population varies between 6.6% and 12%. Insomnia is a sleep disturbance related to a reduction in the quality or quantity of satisfactory sleep. Among the available treatments, there are both pharmacological and non-pharmacological approaches. One recent possible non-pharmacological approach that has been suggested is based on the use of probiotics and the gut-brain axis. There has been increasing scientific focus on this area because of the suggested importance of enteric microbiota in relation to many aspects of health. It has been proposed that probiotics can be used to interact with the intestinal environment to benefit individuals suffering from a variety of conditions. In relation to sleep, some studies have indicated that gamma-amino butyric acid (GABA) produced by the intestinal microbiota may influence the central nervous system (CNS) through the vagus nerve and have an influence on sleep. In this sense, Lactobacillus is one of the major GABA producing bacteria in the gut microbiota. Objective • Our hypothesis is that supplementation with Lactobacillus as a probiotic might improve sleep pattern and quality, acting as an ally in the treatment of insomnia. Design • In the present study, a search was conducted in Pubmed and Google Scholar databases, looking for articles with themes related to probiotics, intestinal microbiota and sleep. Results • No clinical trials were found that evaluated the effect of probiotics for sleep disorders in humans.Conclusions • Research and clinical use of probiotics have been growing due to their health benefits in several areas. In addition, the use of probiotics for sleep and emotional disorders, such as insomnia, stress, anxiety and depression, is gaining space. This way, future research can help developing complementary treatments for people with insomnia and other sleep disorders.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effects of Major Ozone Autohemotherapy on Physical Functionality and Quality of Life in Fibromyalgia Syndrome: A Prospective Cross-sectional Study
Mesut Bakir, MD;  Gülçin Gazioglu Türkyilmaz, MD;  Sebnem Rumeli, MD, PhD
Context • No specific treatment exists for fibromyalgia syndrome (FMS), and usually patients continue to experience pain indefinitely and their quality of life decreases. Major ozone autohemotherapy (MAH) is a complementary treatment for FMS that stimulates the body’s antioxidant system. Objective • This study aims to prospectively evaluate the effects of MAH on pain, quality of life, and general health status in FMS. Design • The research team designed a prospective cross-sectional study. Setting • The study took place at the algology clinic at Mersin University in Yenisehir, Mersin, Turkey. Participants • Participants were 40 patients with FMS, aged 18 to 65, who were admitted to the clinic between February 15 and August 15, 2019. Intervention • Participants completed 13 sessions of major ozone autohemotherapy (MAH), two sessions per week in the first five weeks and one session per month for the remaining three months. In the following three months, the last administered dose was repeated. Outcome Measures • Patients completed the Fibromyalgia Impact Questionnaire (FIQ) and the Quality of Life-short form (SF-36), at baseline (PRE), at five weeks after 10 sessions of MAH (PT), at 9 weeks after 11 sessions (PT1), and postintervention at 17 weeks after 13 sessions (PT3). Results • Significant improvement in FIQ and SF-36 scores was observed in all periods compared to the previous period (P < .05). Between two consecutive measurements the most prominent improvements in both FIQ scores (P < .001) and SF-36 scores was observed between baseline and the PT period (P < .001). Significant improvement also occurred in all SF36 subscale scores between PT and PT3 (P = .02). Conclusions • The study was the first to demonstrate the efficacy of MAH for fibromyalgia patients as found using FIQ and SF-36 questionnaires repeated at certain intervals. The study found that MAH provided improvements in quality of life and general health status for FMS patients.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effectiveness of Physical Therapy for Improving Constipation In Spastic Cerebral Palsy
Waqar Ahmed Awan, PhD;  Raheela Kanwal, PhD;  Tahir Masood, PhD
Background • Bowel and bladder problems in children with cerebral palsy (CP) negatively affect both the children and their families. Routine physical therapy (PT) may contribute to relieving constipation in children with CP by reducing spasticity. Objective • To determine the effectiveness of PT in relieving constipation in children with spastic CP. Design • This was a single-blinded randomized crossover trial (Clinical Trail # NCT03379038) that included 35 children with spastic CP. The children who fulfilled the inclusion criteria were randomly assigned to one of two groups: the progressive physical therapy (PPT) or the maintenance physical therapy (MPT) group. Methods • Data was collected via general demographic questionnaire, defecation frequency (DF) questionnaire, Constipation Assessment Scale (CAS) and the Modified Ashworth Scale (MAS) at baseline and at the 2nd, 4th, and 6th week before and after crossover. The Mann Whitney U-test was used for between-group comparisons and the Friedman and Wilcoxon signed-rank test for post hoc analysis tests were used for within-group changes. To determine the relationship between spasticity and constipation, simple linear regression was used. Setting • National Institute of Rehabilitation Medicine, Islamabad, Pakistan. Results • Neither group showed a significant difference in spasticity level or DF at baseline or at the end of the 2nd week. However, at the end of the 4th week (PPT = 4[1] vs MPT = 2[1]; U = 192; P < .001) and 6th week (PPT = 4[1] vs 3(1); U = 158; P < .001) DF was significantly better in the PPT group than in the MPT group. Regarding constipation severity, the PPT group showed significantly better results on all items of the Constipation Assessment Scale (CAS) compared with the MPT group after intervention (P < .001). The results showed that spasticity was significantly correlated with DF (r = -0.81; P < .001) and constipation severity (r = 0.45; P < .001). Conclusion • Physical therapy significantly improves DF and reduces constipation severity in children with spastic CP.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effects of Qigong Exercise on Physical and Cognitive Performance in Young Sedentary Females: A Quasi-Experimental Design, Placebo-Controlled Study
Martin Burtscher, MD, PhD;  Kultida Klarod, PhD;  Suphannika Ladawan, PhD;  Sanita Singsanan, PhD;  Niramon Thamaviriyasati, PhD
Background • Qigong exercise represents one type of traditional Chinese exercise that might positively affect physical and psychological functioning, slow down disease development and improve quality of life. However, study findings are somewhat conflicting and mechanisms contributing to expected beneficial effects are rather poorly known. Objective • This study aims to evaluate the effects of qigong exercise training for 8 weeks on selected physical, cognitive, and biochemical outcomes in young sedentary females. Method/Design • Quasi-experimental design, placebo-controlled study. Setting • The study was performed at the Department of Physical Therapy, Faculty of Allied Health Science, Burapha University, Bangsean, Chonburi province, Thailand. Participants • Participants were 41 females with sedentary lifestyles. Interventions • 41 sedentary females were allocated to qigong exercise (QG, n = 20) or to the control group (CG, n = 21). Primary Outcome Measures • VO2 max predicted from step testing, aspects of cognitive functions (e.g., digit span forward, DSF, and digit span backward, DSB, task), hematological and biochemical parameters, and body composition were assessed in both groups before and after the 8-week training period. Results • Physical performance (estimated VO2 max) significantly increased after qigong training compared to the CG (P < .001). Working memory (DSB) increased after intervention only within the QG (P = .009) but changes did not reach significance between the groups. Changes in neutrophils (potential mediators of inflammation) tended to be improved in the QG in comparison to the CG (P = .075). Body composition remained unchanged. Conclusion • These findings indicate that 8 weeks of qigong training increased aerobic capacity and tended to improve working memory in otherwise sedentary young females. Neutrophils tended to decrease within the QG. Thus, it was speculated that enhanced oxygen supply to the brain and the decrease of neutrophils adhering to cortical capillaries might have contributed to improved cognitive function.
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December, 2021 - VOL. 27, NO. 12  December, 2021
The Effect of Acupressure Applied to Sanyinjiao (SP6) on Primary Dysmenorrhea
Yeliz Dincer, PhD;  Umran Oskay, PhD
Context • With the technological developments and advancement of scientific knowledge in the field of health, healthcare professionals are now expected to identify strategies for the use of complementary therapies and to guide healthy and ill individuals in their correct and effective use. Acupressure—a simple, effective, safe, and economical therapy—may reduce the pain caused by dysmenorrhea. Objective • The aim of the study was to determine the benefits of acupressure applied to the Sanyinjiao (SP6) acupressure point for treatment of primary dysmenorrhea. Design • The research team designed a randomized controlled trial. Setting • The study took place at the Health Services Vocational School at Duzce University in Duzce, Turkey. Participants • Participants were 67 students with dysmenorrhea, who were studying business administration at the university between October 2016 and January 2018. Intervention • Participants were randomly assigned to one of two groups, in compliance with the study’s criteria. The acupressure group pressed the SP6 acupressure point on each leg once a day for 10 minutes, for the first three days of each menstrual period for three months. The students in the acupressure and placebo group have been followed up for a total of four cycles. The participants in the acupressure group have been advised to press to the SP6 acupressure point for ten minutes every day on each leg for the first three days of each menstruation period for three months; the participants in the placebo group have been recommended to scrub the sham-acupressure point for ten minutes every day on each leg for the first three days of each menstruation period for three months. Within the last month(Month 4), evaluation forms have been applied without any further practices. The control group rubbed a false acupressure point on each leg once a day for ten minutes, for the same period. Outcome Measures • A diagnostic form was used to collect the study’s data and to determine participants’ demographic characteristics. A visual analogue scale (VAS) and the Brief Pain Inventory (BPI) were used to evaluate dysmenorrhea pain. A satisfaction form was used to evaluate participants’ satisfaction. Results • On the VAS, the severity of pain was lower in the acupressure group than in the control group. On the BPI, the scores were lower and the pain caused less discomfort in the acupressure group than in the control group. Moreover, both groups were satisfied with the practices. Conclusions • Acupressure can be used as an effective and reliable method for the management of primary dysmenorrhea.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Prakriti Analysis of COVID 19 Patients: An Observational Study
Shazi Arazzum, BAMS;  Nisha Garg, BAMS;  Mohammad Idris, MD;  Nitin Jindal, MD;  Mahendra Kumar, PhD;  Ankur Kumar Tanwar, BAMS;  Raj K. Manchanda;  Yogita Munjal, MD;  Kiran Nimabalkar, MD;  Neha Parmar, BAMS;  Sujata Rajan, MD;  Manoj Shamkuwar, MD, PhD;  Amit Sharma, MD;  Indu Sharma, BAMS;  Jagnnath Verma, BAMS;  Manisha Yadav, BAMS
Rationale & Objective • The concept of Prakriti is unique to Ayurveda, which is used for deciding the preventive and curative strategy to be adopted in the treatment of patients. It is the total of anatomical, physiological, and psychological domains of an individual. The diseases often manifest by susceptibility that depends upon Prakriti of individuals. COVID 19 is a new disease, where the status of the susceptibility of its victim in terms of Prakriti is not known. This study has been undertaken to determine the Prakriti of COVID 19 positive patients. Method • The validated instrument CCRAS Prakriti assessment scale has been applied to the COVID 19 positive patients admitted between 16 May 2020 to 10 June 2020 at COVID hospital. Result • Data of 117 patients aged 10 to 80 years have been analyzed. The ratio of male-female patients was 1.8:1. Most patients belonged to Vata-KaphaPrakriti (27%).Individuals with their Prakriti found in order of frequency were Pitta-Kapha (21%), Kapha (20%), Vata (13%), Vata-Pitta (11%), Sama (4%) and Pitta (3%). Conclusion • Patients with Vata-Kapha, Pitta-Kapha, and Kapha dominant Prakriti have been found more in COVID19. The treatment strategies can be accordingly decided in respect of each patient.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Is Musical Auditory Stimulation Able to Influence the Recovery of Autonomic Modulation After Exercise?
Luana Almeida Gonzaga, MSc;  Vítor Engrácia Valenti, PhD;  Anne K. França Da Silva, PhD;  Rayana Loch Gomes, PhD;  Rafael Luiz de Marco, MSc;  Luiz C. Marques Vanderlei, PhD;  Sany Martins Pérego, BSc;  Felipe Ribeiro, MSc
Context • The effects of musical auditory stimulation on the human body have received considerable interest, especially when related to health and wellbeing, so the objective was to verify the influence of classical music exposure on autonomic modulation in recovery after exercise. Methods • 35 healthy young men aged 21.74 ± 2.59 years were evaluated. Volunteers perform 2-day evaluations, 1 day without musical stimulus and 1 with musical stimulation through classical music during exercise and recovery. Physical exercises were performed on a treadmill with an intensity of 6.0 km/hr + 1% of inclination in the first 5 minutes for physical “warm-up”, followed by 25 minutes with an intensity equivalent to 60% of the maximum velocity (Vmax), with a same slope according to the Conconi’s threshold. Finally, the volunteers remain at rest for 60 minutes for recovery. Heart rate variability (HRV) was analyzed in some moments of recovery by linear (RMSSD, SDNN, LF and HF (milliseconds squared and normalized unit) and LF/HF ratio, RRtri, TINN and the Poincaré plot: SD1, SD2 and SD1/SD2) and nonlinear indexes (DFA Total, DFA Alpha 1 and Symbolic Analysis: Shannon’s Entropy, 0V%, 1V%, 2LV% and 2ULV%). Results • No differences were found in the comparison between the values of the HRV indexes between protocols and interaction moments vs protocols. Differences were observed between the moments for most indexes (P < .05). Conclusions • Classical music did not significantly influence the autonomic control of heart rate in the recovery phase after submaximal exercise.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Fibromyalgia: A Report of 2 Cases Treated With Homeopathy
Vipul Gandhi, MD
Fibromyalgia is a chronic condition that is characterized by widespread pain and a multitude of other symptoms, including fatigue, sleep disturbances, cognitive dysfunction, stiffness, and depressive episodes. Fibromyalgia is most common in women, though it can occur in men as well. It most often starts in middle adulthood but can occur in the teen years and in old age. Fibromyalgia has also been termed central pain amplification disorder, meaning the volume of pain sensation in the brain is turned up too high. This study has been conducted to evaluate the role of homeopathic treatment in fibromyalgia, a chronic pain disorder which a physician may come across fairly commonly in their practice. Homeopathy has demonstrated great efficacy in mitigating the symptoms of widespread pain, sleep disturbance, and fatigue, which are the most commonly reported symptoms of fibromyalgia.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Complete Blood-count-based Inflammatory Score (CBCS) of COVID-19 Patients at Tertiary Care Center
Haider Ali, MPharm;  Ruchita Banseria, MD;  Kanika Goyal;  Gaurav Gupta, PhD;  Sunil Kumar Gothwal, MD;  Khalid Saad Alharbi, PhD;  Mayank Shrivastava, MD;  VB Singh, MD;  Saranshi Singh, MBBS;  Yogendra Singh, MPharm
Context • Inflammation is a significant factor driving the rise of multiple cases of viral pneumonia, including COVID-19 infection. Peripheral white blood cells (WBCs), the neutrophil (NEU)-to-lymphocyte (LYM) ratio (NLR), the platelet-to-lymphocyte (PLR) ratio, and hemoglobin (Hb) are markers of systematic inflammatory reaction and often predict disease severity. Objective • The current study intended to examine the prognostic importance of hemoglobin (Hb), total leukocyte count (TLC), absolute neutrophile count (ANC), absolute lymphocyte count (ALC), NLR, d-NLR [derived NLR = ANC/(WBC-ANC)], absolute platelet count (APC), and PLR, based on complete blood counts (CBCs) for COVID-19 patients. Design • The research team designed a retrospective that was conducted between March 27 and June 5, 2020, after the first COVID-19 case was reported in Ajmer, Rajasthan, India on March 27. Setting • The study took place at Jawaharlal Nehru (JLN) Medical College in Ajmer, Rajasthan, India. Participants • The study included 364 participants who were all COVID-positive patients who came to the hospital during the study’s period, including patients from various age groups and of both genders. Outcome Measures • Using the results of the CBC, the research team measured: (1) Hb in g/dl, (2) ANC, (3) ALC, and (4) APC. The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) were calculated from measurements of the levels of the circulating biomarkers, as cells × 103/µl. Result • For participants who were severely symptomatic, the mean age was 57.86 ± 8.92. Males were more likely to experience severe symptoms. Participants’ Hb values were significantly different between groups, and TLC, ANC, NLR, d-NLR, and PLR were highest in the severely symptomatic group and lowest in the asymptomatic group. NLR was positively associated with a risk of COVID-19 pneumonia, while Hb was negatively associated with development of pneumonia. Conclusions • Disease severity and age are independent predictors of poor outcomes. The NLR should be used as a routine blood test that can help in the diagnosis of disease severity in COVID-19. NLR is very simple tool that can be used as a fast and low-cost test that is easily available, even in small centers where the facilities for other tests, such as tests of LDH, CRP, and IL-6, and high resolution CT scans aren’t available. Thus, NLR can be used as single independent predictor of COVID-19 disease severity.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Progress in the Study of Epidemiologic Characteristics and Influencing Factors of Asymptomatic Malaria Infection in Africa
Yun Bai, MBBS;  Jing Chen, MBBS;  Zheng-xin He, MBBS;  Fu-Kun Wang, MBBS
Malaria is caused by protozoan parasitic Plasmodium infections. Plasmodium falciparum is common in Africa; P ovale, P malaria and P vivax infections are less prevalent and globally confined, contributing to major causes of global mortality and morbidity, particularly in children in sub-Saharan African countries. In 2018, the total incidence of malaria increased from 221 million to 229 million, with an estimated 503 000 deaths reported. Sub-Saharan Africa has the highest number of cases of malaria and highest mortality rate compared with other countries, like southeastern Asia, east Pacific, western, and America with an estimated 213 million cases. In addition, continuous exposure to Plasmodium parasites results in the production of partial immunity to guard against more problems, resulting in asymptomatic carriers. The diagnosis of asymptomatic malaria is not simple because of the apparent absence of clinical factors and sometimes low levels of parasites. The most basic concept appears to be parasitemia and a lack of malaria signs, primarily fever (axillary temperature <37.5° C). Thus, a better awareness of asymptomatic malaria epidemiology in affected countries will help improve strategies to reduce the local burden of malaria and its health consequences. Therefore, the objective of this study was to determine the magnitude of asymptomatic malaria pathology and related risk factors with epidemiologic characteristics in individuals on the African continent.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Risks Faced by Nurses and Mitigation Strategies for the Daytime Operating Room: A Review
Hongju Dai, MBBS;  Kaili Wu, MBBS;  Xue Yang, MBBS
Nurses and the nursing profession are the ultimate components of the healthcare system, especially in the operating room, and nurses are exposed to many risks and hazards in the course of performing their jobs. Overall, this appeared to be negligible across the world. Our study aims to give an overview of the risks and safety concerns of operating room nurses as reported in the literature and to look at the strategies or countermeasures that can be taken to surmount them. Major needle and sharps injuries. radiation and surgical smoke exposure, back pain, excessive workloads and patient handling-related injuries were reported extensively. Appropriate precautions, adequate training and experience, enactment of local protocols and policies, creation of a favorable working atmosphere, adequate rest and colleague support can all help overcome these concerns to an extent. At the institutional and political level, effective countermeasures should be taken to guarantee the welfare of competent operators for improved healthcare. Further studies are also required of operating room staff on the risk of chronic diseases and illness in those individuals who have been exposed to atmospheric gasses and smoke.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effects of Valsalva Maneuver, EMLA Cream, and Stress Ball for Pregnant Women’s Venipuncture Pain
Gökhan Dogukan Akarsu;  Rukiye Höbek Akarsu, PhD;  Betül Kus, PhD
Context • Peripheral intravenous catheter (PIVC) practice is a common invasive procedure used in the diagnosis and treatment of pregnant women admitted to the hospital. Difficulties experienced during PIVC application are among the most common problems encountered in a medical facility. Objective • The study intended to evaluate the effects of the Valsalva maneuver, the application of eutectic mixture of local anesthetics (EMLA) cream, and use of a stress ball in controlling the pain and discomfort that developed due to PIVC administration for pregnant women. Design • The research team designed the study as a randomized, controlled, single-blind trial. Setting • The research took place at the obstetrics clinic at the Practice and Research Hospital at Yozgat Bozok University in Yozgat, Turkey, between January 2019 and February 2020. Participants • Participants were 120 pregnant women who visited the obstetrics clinic and were admitted to the maternity ward of the hospital during that time. Intervention • Participants were divided into four groups of 30 women each: (1) the Valsalva maneuver group, (2) the EMLA group, receiving an application of the cream, and (3) the stress-ball group, and (4) the control group. Outcome Measures • Data were collected through the use of a pregnancy information form and a visual analog scale. In the assessment of the data, variance analysis was used with the Kruskal Wallis and Dunn test. Results • Only the pain scores of the Valsalva maneuver group were found to be significantly lower than those of the control group, whereas the pain scores of the EMLA and stress-ball groups were similar to those of the control group. Conclusions • The current study can generate awareness in pregnant women in terms of choosing between pharmacological and nonpharmacological practices that nurses use during PIVC insertion. As the only randomized controlled blind study that has been performed on the topic, the current study offers nurses evidence of a way to reduce PIVC pain in pregnant women.
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December, 2021 - VOL. 27, NO. 12  December, 2021
The Effect of Body Acupressure on Blood Pressure and Fatigue Levels in Individuals Suffering From Hypotension During Hemodialysis: A Randomized Controlled Trial
Sevil Biçer, PhD;  Sultan Tasci, RN, PhD
Background/Aim • Since hypotension is one of the most common complications experienced during hemodialysis (HD), and there are studies indicating that stimulation of the P6 (Neiguan) acupuncture point affects blood pressure, this study examines the effect of acupressure performed on this point on blood pressure regulation as well as its effect on symptoms such as hypotension-associated fatigue and pain. This randomized controlled trial was conducted in order to determine the effect of 12-session body acupressure, performed by electrostimulation device, on blood pressure, headache, and fatigue level in individuals suffering from hypotension during hemodialysis. Methods • The study was conducted with a total of 135 patients, including 67 patients in the intervention group and 68 patients in the placebo group at four hemodialysis centers located in two city centers. The data were gathered using a questionnaire, visual analog scale (VAS) for pain and fatigue, and the Piper fatigue scale. The forms were administered at the beginning of the application (first follow-up) and four weeks later (second follow-up). In the intervention group, the electrostimulation device was attached to the Neiguan (p6) acupuncture point and operated at the third hour of each dialysis session three times a week for one month. In the placebo group, the device was attached to the same acupuncture point but its batteries were removed and it was not operated. At the end of the four-week application, the forms were administered again. One-way analysis of variance, t test, Student-Newman-Keuls test, Pearson correlation analysis, Chi-square, McNemar test and McNemar Bowker test were used to assess the data. Results • It was found that systolic and diastolic blood pressure levels were higher in all sessions in the intervention group compared to the placebo group (P < .05). In the first follow-up, no difference was observed between the groups in terms of the scores of VAS pain, VAS fatigue, and Piper fatigue scale (P > .05); whereas, in the second follow-up, it was determined that VAS pain scores, VAS fatigue scores, and affective, sensory, and total scores of the Piper fatigue scale decreased in the intervention group compared to the placebo group (P < .05). Conclusions • As a conclusion; it was found that body acupressure, which was performed on the Neiguan (P6) acupuncture point using electrostimulation device, provided the systolic and diastolic blood pressure regulation and decreased VAS pain severity, VAS fatigue severity, and total score and subscale mean Piper fatigue scale scores.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Clinical and Anthropometric Improvements with a Tailored Dietary Approach in Pediatric Crohn’s Disease
Jennifer Masters, MS, RDN, LDN, CLT, IFNCP;  Michael A McLean, PhD;  Cory T Strobel, MD;  Gustavo G Zarini, PhD, RD
Pediatric Crohn’s disease (CD) is more common today than in prior decades. Therapeutic goals in children with CD are to reduce symptomatology, promote normal growth, and avoid nutritional deficiencies. Diet plays a crucial role in the treatment of CD. However, there is a lack of comprehensive guidelines and individualized dietary approaches. A 12-and-a-half-year-old boy presented with chronic diarrhea, intermittent fever, abdominal pain, and a history of eczema. At the first visit, his body mass index (BMI) was 14.4, and his BMI-for-age was in the 1st percentile, classifying him as underweight. He received the diagnosis of Crohn’s ileocolitis and gastritis and was unresponsive to treatment for 10.5 months. The patient was placed on a tailored dietary approach based on the in vitro leukocyte activation assay-MRT (LAA-MRT®), known as the Lifestyle Eating and Performance (LEAP) program. The LEAP program is an elimination diet built on the selection of less-immune-reactive foods and chemicals identified by the LAA-MRT® results. After 39 days of following the LEAP program, his fecal calprotectin levels decreased from >2000 µg/g to 185.9 µg/g. A repeat esophagogastroduodenoscopy (EGD) and colonoscopy with 10 biopsies showed complete histologic remission 1 year after beginning diet therapy. At that point, the patient discontinued his pharmacologic therapy and maintained clinical remission of CD after more than 3 years of follow-up. In addition, his anthropometric measurements and laboratory biomarkers were normalized. This case presents evidence supporting the use of the LEAP program in clinical practice as an adjunctive, tailored dietary option to manage pediatric CD.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Evaluation of Individualized Homeopathic Treatment in Patients With Irritable Bowel Syndrome: A Pilot Study
Jessica M García-Vivas, PhD;  Gloria Hernández-Ruíz, MD;  Brenda Ruth Martínez-Islas, MD;  Olivia Medel-Flores, MSc;  Elvia Pérez Soto, MSc;  Virginia Sánchez-Monroy, PhD
Background • Some studies have suggested the efficacy of homeopathic treatment for irritable bowel syndrome (IBS). Objective • The aim of this pilot study was to evaluate the efficacy of individualized homeopathic treatment in patients with IBS. Methods • The study was carried out at the National Homeopathic Hospital of the Secretary of Health, Mexico City, Mexico and included 41 patients: 3 men and 38 women, mean age 54 ± 14.89 years, diagnosed with IBS as defined by the Rome IV Diagnostic criteria. Single individualized medicine was prescribed for each patient, taking into account all presenting symptoms, clinical history, and personality via repertorization using RADAR Homeopathic Software (archibel, Isnes, Belgium). The homeopathic drugs were used at fifty-millesimal (LM) potency per the Mexican Homeopathic Pharmacopoeia starting with 0/1 and increasing every month (0/2, 0/3, 0/6). Severity scales were applied at the beginning of treatment and every month for 4 months of treatment. The evaluation was based on comparing symptom severity scales during treatment. Results • The results demonstrated that 100% of patients showed some improvement and 63% showed major improvement or were cured. The study showed a significant decrease in severity of symptom scores 3 months after treatment, with the pain score showing a decrease 1 month after treatment. The results highlight the importance of individualized medicine regimens using LM potency, although the early decrease in pain observed could also be due to the fact that Lycopodium clavatum and Nux vomica were the main homeopathic medicine prescribed, and these medicines contain many types of alkaloids, which have shown significant analgesic effects on pain caused by physical and chemical stimulation. Conclusion • This pilot study suggests that individualized homeopathic treatment using LM potencies benefits patients with IBS.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Psychological Issues Among Diabetic Patients and the Effect of Psychological Nursing on Patients’ Well-Being: An Overview of the Literature
Muhammad Ayaz, PharmD;  Lin Luo, BD;  Hongmin Tian, BD
Background • Positive psychological interventions like self-efficacy, optimism, resilience, and patient well-being have a great influence on the clinically improved positive outcomes of medically ill individuals. In diabetic individuals, these positive psychological interventions have been linked with improved positive outcomes. In past decades, the importance of psychological support for diabetic individuals has been recognized and psychological counseling for such individuals has been recommended for improved positive outcomes in these individuals. Methods • The current study aims to highlight the role of nurse in managing the impact of diabetes and the effect of psychological characteristics, including self-efficacy, resilience, optimism, and the well-being of diabetic patients on the positive outcomes. Research published in recognized journals published between 1970 and 2020 relating to diabetes, psychological nursing, self-efficacy, optimism, resilience, depression, anxiety, stress, and health outcomes were searched via search engines, including SciFinder, PubMed, Scopus, Google Scholar, Web of Science, JSTOR, EBSCO, and PROTA. The study was conducted according to PRISMA guidelines and studies that did not link diabetes and psychological nursing with these issues or that lacked proper controls were excluded from the study. Results • Review of the articles indicated a significant degree of relation between psychological nursing and the physical and psychological well-being of diabetic patients. The psychological impact of diabetes, including anger, feeling loss, anxiety, and depression, are of great importance and can influence the disease state of diabetic patients. Psychotherapy assesses the patient to address the behavioral and emotional aspects of diabetes. Addressing the psychological impacts of diabetes plays a significant role in the treatment of diabetes, leading to better glycemic control. In diabetic patients, positive psychological characteristics are linked with fewer diabetic complications, reduced mortality and improved glycemic control. There are a number of ways in which a nurse can effectively manage complications associated with diabetes. Conclusions • Positive psychological interventions, self-efficacy, optimism, resilience, and the well-being of patients play significant roles in addressing the mental illnesses associated with diabetes and have shown improved positive outcomes in diabetic patients. Negative psychological characteristics like depression, anxiety, and stress are linked with poor health outcomes but can be effectively managed via psychological nursing.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Adjunctive Treatment of Pediatric Adenoidal Hypertrophy: A Review
Murat Çetkin, PhD;  Hatice Esra Çetkin, PhD
Context • Adenoids play an important role in the protection of the upper respiratory tract against pathogens. Nonphysiological enlargement of adenoids is defined as adenoid hypertrophy (AH). In treating AH, physicians prefer medical therapy and often disregard adjunctive methods. Studies on the effects of adjunctive methods on adenoid tissue are quite scarce. Objective • The current review aims to examine the clinical studies that have investigated adjunctive methods—nasal irrigation, herbal therapy, bacteriotherapy, and halotherapy—used to treat AH and its associated symptoms and to evaluate their effectiveness in pediatric patients. Design • The research team performed a narrative review by searching seven electronic databases (Pubmed, Cochrane Library, Google Scholar, Web of Science, EMBASE, Science Citation Index and Elsevier) were used for the literature search. The search used the keywords adenoid hypertrophy, adjunctive treatment, nasal irrigation, herbal medications, bacteriotherapy and halotherapy. Setting • This study was took place in Department of Anatomy, Medicine Faculty, Istanbul Medeniyet University. Results • The nasal irrigation with hypertonic solution decreased to size of enlarged adenoid tissue. The bacteriotherapy used with nasal spray and tablet form decreased to surgery rate and adenoid size.The adenoid and/or tonsillar hypertrophy were decreased by halotherapy used with micronized, iodized-salt aerosol. Conclusions • A review of studies on this matter indicates that the studied adjunctive methods can be used safely in the treatment of AH, either separately or in combination with conventional medical treatment. However further clinical studies are needed on this topic.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Nano-Delivery Systems for Improving Therapeutic Efficiency of Dietary Polyphenols
Omnia Magdy Hendawy, PhD
Dietary polyphenols, primarily categorized into flavonoids (flavanols, flavones, flavan-3-ols, anthocyanidins, flavanones, and isoflavones) and nonflavonoids (stilbenes and phenolic acids) are reported to have health-promoting effects, such as antioxidant, anti-inflammatory, antitumor, antibacterial, antiviral, and cardioprotective properties. However, their applications in functional food and medications are limited due to their low bioavailability and insufficient systemic delivery. Nano-delivery system conveyances frameworks astoundingly influence the take-up properties of the stacked atoms because the molecule small shape, size, and surface properties of the nanoparticles apply a vital role in the improvement of the systemic delivery of polyphenols This includes nano-emulsion, nano-encapsulation, polymer nanoparticles (NPs), nano-liposomes, solid liquid nanoparticles, cyclodextrins, and polyphenol-loaded hydrogels. Nano-technology is a rapidly developing area that guarantees the improvement of materials with novel measurements, new properties, and more extensive scope for utilization. This review reports the different therapeutic applications of dietary polyphenols, their biological activities, and different nano-delivery systems successfully developed for overcoming the delivery challenges. These applications also seek to improve their bioavailability, reduce toxicity, and enhance dietary polyphenol uptake across the gastrointestinal tract.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effects of Three Months of Honey Supplementation on Quality of Life and Neuropathy in Type 2 Diabetic Patients
Zachariah Bobby, PhD;  Gopal Krushna Pal, MD, PhD;  Pravati Pal, MD;  Girwar Singh Gaur, MD;  Allampalli Sirisha, MSc;  Bettadpura Shamanna Suryanarayana, MD
Context • Diabetic neuropathy, a common debilitating complication of type 2 diabetes, can occur despite adequate treatment. To date, no studies have occurred on the use alternative medicine as an adjunct therapy for treating diabetic neuropathy. Objective • The study assessed the effects of three months of honey supplementation on insulin resistance, lipid profiles, oxidant status, nerve conduction, and QOL in patients with diabetic neuropathy. Methods/Design • The research team designed a single-arm, open-label pilot study. Setting • The study took place at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) in Puducherry, India. Participants • The study included 48 patients with diabetic neuropathy at the institute, with a mean age of 58.91 ± 7.976 years. Intervention • Participants took honey for three months at a dose of 0.5 gm/Kg of body weight per day. Outcome Measures • Participants completed the Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire and the Norfolk QOL Diabetic Neuropathy (Norfolk QOL-DN) questionnaire at baseline and postintervention. Also, participants’ glucose levels, lipid profiles, and biochemical markers were obtained and a nerve conduction study was completed at baseline and postintervention. Results • A significant reduction occurred in the NTSS-6 score (P < .0001) and the Norfolk QOL-DN total score (P < .0001) from baseline to postintervention. Participants’ fasting blood glucose (FBG), triglycerides (TG), and total cholesterol (TC) decreased significantly, at P = .0192, P = .0371, and P = .0049, respectively. Their malondialdehyde (MDA), and inflammatory markers interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-a) also decreased significantly, and MDA showed a significant correlation with neuron specific enolase (NSE). Conclusions • Three months honey supplementation reduced participants’ subjective pain scores and symptoms from diabetic neuropathy and improved their QOL. However, the nerve conduction study showed that no significant change had occurred in motor velocity.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Burnout Syndrome: Therapeutic Approach With Beneficial Effects on Personality and Quality of Life
Mari? Adina;  Aurel Nirestean, MD, PhD;  ?tefan Cristian Vesa, MD, PhD
Context • The World Health Organization (WHO) has defined burnout syndrome (BOS) as resulting from chronic workplace stress that hasn’t been successfully managed. Until now, BOS has been treated using allopathic drugs and psychotherapy because it has been confused with major depressive syndrome. Objective • The aim of the study was to examine the effectiveness of hypnotherapy combined with cognitive-behavioral therapy in changing the personality traits and lifestyles of people in professions vulnerable to stress who have developed BOS. Design • The research team designed a one-group pre-and posttest study. Setting • The study was conducted in a private-practice office in Targu Mures, Romania. Participants • Participants were 30 patients at the private practice who had been diagnosed with BOS and volunteered to participate in the study. Intervention • The study alternated hypnotherapy sessions with psychological-counseling sessions, using a general therapeutic plan for all patients and customizing the plan for each participant. Outcome Measures • The study measured participants’ BOS symptomatology and personality dimensions using the Maslach Burnout Inventory (MBI), the DECAS Personality Inventory, the Personality Inventory for DSM-5 (PID5), and the Survey of Work Styles (SWS). Results • Significant changes occurred between baseline an postintervention in the dimensions of extraversion, agreeability, and emotional stability as well as impatience, anger, work involvement, time urgency, job dissatisfaction, and competitiveness. Significant differences existed in almost all personality traits evaluated with the PID-5 (P < .05). Conclusions • The combination of hypnotherapy and psychological counseling can treat BOS, increasing patients’ quality of life by decreasing negative personality traits. The present study is important because it proposes a new therapeutic approach to BOS.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effects of Red Pepper, Ginger, and Turmeric on Energy Metabolism: Review of Current Knowledge
Nilüfer Acar Tek, MSc, PhD;  Mehmet Arif Icer, MSc
Context • Energy metabolism is the main determinant of obesity etiology. Consumption of some spices, such as red pepper, ginger, and turmeric, can be considered to be an environmental factor affecting energy metabolism. Objective • This review aimed to examine the effects of red pepper, ginger, and turmeric on weight control, weight loss, and energy metabolism. Design • The research team performed a narrative review by searching the Google scholar, Scopus, PubMed, ResearchGate, Web of Science, and Science Direct databases. The search used the keywords red pepper, ginger, and turmeric in combination with energy metabolism, energy expenditure, energy balance, thermogenesis, anti-obesity, weight management, weight control, weight loss, metabolic rate, and oxygen consumption, without considering any time limitation. Setting • This study has been carried out in Ankara / Turkey. Results • Red pepper, ginger, and turmeric affect energy metabolism through various mechanisms. Dietary red pepper and its pungent principle capsaicin affects satiety and has a promising thermogenic influence. Ginger has positive effects on weight control, obesity prevention, and energy metabolism. In addition, curcumin inhibits the conversion of preadipocytes to mature adipocytes. Conclusions • Red pepper, ginger, and turmeric affect energy metabolism using mechanisms related to thermal effect, BMR, total energy expenditure, oxygen consumption, and lipid oxidation. These spices haven’t been assigned appropriate doses and periods of use, and no definite judgments can be made on their use. Therefore, it’s necessary to conduct further randomized controlled research to reach absolute conclusions and determine by which mechanisms these spices show this effect on energy metabolism.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Anthocyanin Supplementation Alleviates Antithrombotic Risk by Inhibiting Platelet Activity in Humans
Natalie Colson, PhD;  Almottesembellah Abdalruhman Gaiz, MB, ChB, PhD(c);  Avinash R Kundur, PhD;  Elham Nikbakht, PhD;  Sapha Shibeeb, PhD;  Indu Singh, PhD;  Lada Vugic, PhD
Background • Platelet hyperactivity has a crucial role in initiating vascular thrombosis and subsequent cardiovascular disease (CVD). Objective • This study aimed to assess the effect of anthocyanins (AC) on platelet aggregation and activation and lipid profile. Study Design • A total of 26 healthy participants consumed 320 mg of AC/day in the form of Medox® capsules for 28 days. Setting • This study was conducted in the laboratories of the School of Medical Sciences, Griffith University, Gold Coast, Australia. Participants • A total of 26 randomly recruited healthy 25- to 75-year-old participants completed this study. Primary Outcome Measures • Fasting blood samples were collected pre- and post-the intervention period to perform platelet activation studies by measuring platelet surface marker expression of CD41a and P-selectin, and platelet-monocyte aggregates in adenosine diphosphate (ADP) stimulated platelets. Platelet aggregation studies were performed by stimulating platelets with various agonists such as ADP, collagen and arachidonic acid. Full blood examination, coagulation and biochemistry profile analyses were also performed pre- and post-intervention. Flow cytometric analysis showed a significant effect of AC on the expression of P-selectin as measured by the platelet surface expression of CD62p. Results • There was a significant reduction of ADP-stimulated platelet aggregation. Hematologic analysis showed a significant reduction of mean platelet volume, mean cell hemoglobin, and mean cell hemoglobin concentration. Coagulation analysis demonstrated significant attenuation of fibrinogen level in the blood. Conclusion • This study showed inhibition of platelet activity, platelet aggregation and mean platelet volume (MPV). These results suggest that AC has a positive impact on attenuating platelet activity, which might minimize thrombotic risk.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effects of Reflexology on Pain, Fatigue, and Quality of Life in Multiple Sclerosis Patients: A Clinical Study
Hatice Dilek Dogan, PhD;  Mehtap Tan, PhD
Context • Multiple Sclerosis (MS), occupies the first row among the diseases which leads to loss of neurological ability without depending on a trauma in the adults. Reflexology is one of complementary therapies based on activating a body’s power to recover itself by special hand techniques applied to feet and hands. Positive changes in spasticity, pain, fatigue, depression, cortisol levels, anxiety, and blood pressure levels have been observed in MS patients after reflexology. Objectives • This study was conducted to determine the effect of reflexology on pain, fatigue and quality of life in MS patients. Design • The study was conducted experimentally by taking pretest and repeated measurements on reflexology and control groups determined by simple randomization. Setting • The study took place in the neurology clinics at two university hospitals in Turkey. Participants • Potential participants were 685 patients at the clinics who had been diagnosed with MS 6 months at least prior to the study. Of that group, 66 patients were included in the study, 33 in the intervention group and 33 in the control group Intervention • Reflexology was applied on each patient in the intervention group for 3 sessions a week for 12 weeks, and weekly pain and fatigue and monthly quality of life were evaluated. No intervention was made to the control group. Both groups received routine treatment. Outcome Measures • Measurements occurred at baseline, weekly and monthly throughout the trial, and postintervention. Pain and fatigue were evaluated weekly using a Visual Analogue Scale (VAS) and the Fatigue Severity Scale (FSS), respectively and quality of life was evaluated monthly using the Multiple Sclerosis Quality of Life-54 (MSQOL-54) scale. Results • In the intervention group, significant decreases were observed in the pain scores from the seventh week and in the fatigue scores from the fifth week (P < .001). In the assessment of quality of life, the combined physical health and combined mental health scores were found to be higher in the intervention group than in the control group (P < .001). Conclusion • The study indicates that reflexology can be used as a complementary and alternative therapy to reduce pain and fatigue and enhance quality of life in MS patients.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Cardiac Rehabilitation Perceptions Among Healthcare Providers in China: A Mixed-Methods Study
Biao Ding, BA, RN;  Sherry L Grace, PhD, CRFC, FCCS, FAACVPR;  Liwen Liang, BA, MA;  Xia Liu, RN, PhD(c);  Zhimin Xu, BA, MD;  Yaqing Zhang, PhD
Background • Cardiac rehabilitation (CR) in China has not been widely adopted for a variety of reasons, including healthcare provider (HCP)s’ lack of awareness and beliefs. Objective • To explore HCP’s perceptions of CR in China. Methods • An exploratory, sequential design was used in this mixed-methods study. Face-to-face semi-structured interviews were performed; this was followed by a cross-sectional survey. Setting • The interviews were conducted in a university-affiliated hospital and a rehabilitation hospital in Shanghai. The survey was conducted in the cardiac departments of primary, secondary, or tertiary hospitals in Shanghai or Yunnan Province, China. Participants • Saturation was achieved upon interviewing 13 HCPs (5 doctors, and 8 nurses). A total of 610 HCPs (185 doctors [30.5%], 417 nurses [68.8%]) completed the survey. Results • Analysis of the interviews revealed 4 themes: the perceived value of CR, the need for pro-CR policy, variability in CR awareness, and obstacles to CR delivery. HCP approaches to the treatment of patients with cardiac conditions did not universally include exercise training (only approximately 60% of HCPs), or all other recommended domains of secondary prevention, and assessment of the major risk factors was quite low. Familiarity with CR was moderate (48.7%). HCPs perceived that philosophies of Traditional Chinese Medicine (TCM) were highly compatible with, and could add value to, CR. HCP approaches to secondary preventive care and CR perceptions varied significantly according to their highest level of education, clinical profession, job seniority, type of hospital where they worked, whether the hospital had a CR program and the hospital’s location. Conclusion • HCPs recognize the value of CR, particularly considering secondary preventive care practices were not comprehensive. Education is needed to improve HCPs CR awareness.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Effect of Herbs on Postoperative Intestinal Obstruction: A Case Report
Hai-Yong Chen, PhD, MD;  Lixing Lao, PhD;  Baoyi Shao;  Shuiyan Zhang, MD
Postoperative intestinal obstruction is one of the most common and challenging complications after patients receive pelvic or abdominal surgery. The effectiveness of conventional therapies is varied and they are associated with a high recurrence rate. Traditional Chinese Medicine can be beneficial in the treatment of intestinal obstruction. In this case, a 65-year-old woman had progressively increasing abdominal pain, distension, and constipation following total hip replacement surgery. The patient was diagnosed with partial intestinal obstruction and was treated for 6 days without success using conventional Western medicine, including Enema Glycerini and Sodium Phosphates Rectal Solution. We received a request from the surgical department for a Chinese medicine consultation. Two doses of modified Dachengqi Decoction herbal formula were prescribed for the patient. The patient had her first flatus and defecation within 2 hours after ingestion of the first dose of herbal medicine and subsequently all of the symptoms were relieved. The patient was soon discharged without any further complications; a 5-year follow-up indicated that the patient had no recurrence of intestinal obstruction. This case is the first to report the effect of a Chinese herbal decoction in achieving remission of intestinal obstruction with only 1 dose. Large scale randomized controlled trials are warranted to confirm our findings.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Aggravated Respiratory Failure From COVID-19 Infection: Patient Care Management From Nurses in the Intensive Care Unit
Ying Cao, MD;  Jianying Xiong, BD;  Hua Xu, PhD;  Shanggan Zeng, PhD
Context • About 19% of COVID-19-patients undergo hypoxic breathing problems, approximately 14% require intensive oxygen therapy, and 5% require mechanical ventilation and ICU admission. These patients can deteriorate rapidly, so nurses must closely watch them. Objective • The study intended to examine the role of emergency nurses as care providers in intensive care units (ICUs). Design • The research team performed a narrative review by searching the Mendeley, Medline, Google Scholar, ScienceDirect, Springer, and PubMed databases. The search used the keywords COVID-19 infection, epidemiology of respiratory failure pathology in COVID-19 infection, involvement of viral spike protein S of SARSCoV-2, SARS CoV2 transmission, pathophysiology of SARSCoV-2 attack-mediated ARDS, transmission of viral particles of SARSCoV-2 in lungs, mechanism of cytokines in lungs, immunomodulatory response changes in lung physiology, and involvement of nursing officer in nursing patient care management in ICU respiratory failure. Setting • This study were conducted at The First Affiliated Hospital of Nanchang University, China. Results • Nurses are necessarily not only responsible for adequate oxygen management but also for other critical health services to benefit patients, such as control of oxygen saturation and vital signs, to reduce respiratory failure in the ICU. Conclusions • The diagnosis of the root cause of respiratory failure and its treatment are complex because a variety of pulmonary and extrapulmonary conditions can cause respiratory failure. Methods of treating acute respiratory failure and other respiratory illness require a multidisciplinary, collaborative approach. Nurses are in the best position to determine patients’ risks for respiratory distress, observe them during hospitalizations, and evaluate their treatments.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Neem (Azadirachta Indica A. Juss) Capsules for Prophylaxis of COVID-19 Infection: A Pilot, Double-Blind, Randomized Controlled Trial
Mohini Barde, MBBS, MD;  Anju Bhardwaj, MD;  Nidhi Chaudhary, MD;  Asim Das, MD;  Shivani Ghildiyal, MD;  Tanuja Manoj Nesari, MD;  Anil Kumar Pandey, MD;  Galib Ruknuddin, MD;  Rajagopala ShriKrishna, MD;  Girish Soman, MTech
Context • SARS-CoV-2 is a global public-health concern. Interventions to prevent infection are urgently needed. The anti-inflammatory and antiviral effects of neem make it a potential agent for COVID-19 prophylaxis. Objective • The study intended to evaluate the prophylactic effects of neem capsules for persons at high risk of COVID-19 infection due to contact with COVID-19 positive patients. Design • The research team designed a prospective, randomized, double-blind, placebo-controlled, parallel-design study. Setting • The study was conducted at a single center in India. Participants • Participants were 190 healthcare workers at the hospital or relatives of patients with COVID-19 infection. Intervention • Of the 190 participants, 95 were in the intervention group and 95 in the control group. Participants received 50 mg of a proprietary, patent-pending, neem-leaf extract or a placebo orally in capsules, twice a day for 28 days. Outcome Measures • The number of individuals positive for COVID-19 between baseline and follow-up on day 56 was the primary outcome measure. Secondary measures included an evaluation of neem’s safety and its effects on quality of life (QOL) and changes in biomarkers. Results • The mean age of participants was 36.97 years, and 68.42% were male. Total 13 subjects tested positive during the study. All were asymptomatic. Of the 154 participants who completed the study per-protocol, 11 tested positive, 3 in the intervention group and 8 in the control group. The probability of COVID-19 infection in participants receiving the intervention was 0.45 times that of participants receiving the placebo, a relative risk of 0.45, with the effectiveness of the intervention being around 55%. Treatment-emergent adverse events (TEAEs) in both groups were minimal and were of grade 1 or 2 in severity. Biomarkers and QOL remained stable in both groups. Conclusions • The study found a reduced risk of COVID-19 infection in participants receiving neem capsules, which demonstrates its potential as a prophylactic treatment for the prevention of COVID-19 infection. The findings warrant further investigation in clinical trials.
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December, 2021 - VOL. 27, NO. 12  December, 2021
Acupressure for Cancer-Related Fatigue in Elderly Cancer Patients: A Randomized Controlled Study
Ülkü Özdemir, PhD, RN;  Sultan Tasci, RN, PhD
Context • Fatigue is the most common symptom experienced by elderly cancer patients. It negatively affects their daily functioning and quality of life. Integrative approaches such as acupressure can be used to treat cancer-related fatigue in elderly patients. Objectives • The aim of this study was to investigate the effect of acupressure on the severity and level of cancer-related fatigue in elderly patients with cancer. Design • This study was carried out in two stages comprising a quantitative study (pretest, posttest, randomized controlled) and a qualitative study (in-depth interview). Setting • The study was conducted at the hematology and medical oncology clinic in a university hospital in Turkey. Participants • The study included 31 cancer patients aged 65 and over, who were experiencing cancer-related fatigue. Intervention • Participants were randomly assigned to the acupressure group (intervention group) or the control group. The intervention group was administered acupressure on three acupuncture points on the hands and legs (LI4, SP6, ST36) by caregivers or the patients themselves for three minutes twice daily, for a period of four weeks. The acupressure group was examined before and after the four-week intervention. The control group was similarly examined though no intervention was applied. Outcome Measures • Data were collected using Patient Information Form, Visual Analog Scale (VAS), Piper Fatigue Scale (PFS), and Acupressure Experience Patient Opinion Form. Results • In the follow-up examination of individuals in the acupressure group, there was a significant reduction in the severity and level of fatigue compared to the first examination. However, there was no significant difference between the first and second examination of individuals in the control group. The qualitative findings obtained during the in-depth interview support the quantitative findings of the study. Conclusion • Acupressure can be recommended as an integrative treatment for cancer-related fatigue because it is effective, easy to use, tolerable and does not cause serious side effects.
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December, 2021 - VOL. 27, NO. 12  December, 2021
The Effectiveness of Mouthwashes With Various Ingredients in Plaque Control: A Systematic Review and Meta-Analysis
Nuha Helayl Al Waqdani, MS (Endodontics);  Mohammed Katib Alruwaili, PhD;  Khalid Nafea Alsharari, BDS;  Ibrahim Eid Alroudhan, BDS;  Mohammed Gamal, PhD;  Kiran Kumar Ganji, MDS;  Assad Mehmood Khan, FDS RCPS
Objective • Our study sought to present a solid comprehensive overview of the efficiency of active ingredients in mouthwash to control dental plaque. Source • Cochrane Library, the Library of Medicine, (MEDLINE-PubMed), Web of Science database core collection, the database of the American Dental Association (ADA) Center for Evidence-based Dentistry and Scopus database were used for our review and meta-analysis. Methodology • This was a systematic review that included papers with and without a meta-analysis on the efficacy of mouthwashes with various active ingredients in the control of dental plaque. In vitro and animal experiments were excluded from the study. Methodologic quality assessment was carried out with AMSTAR. The estimated plausible risk of unfairness was calculated according to the recording, reporting and methodologic quality of the selected systematic reviews per the PRISMA recommendations for systematic reviews. Results • 580 initial hits were reported and 22 papers were chosen for the overview (kappa = 0.89; good agreement). Of these, 12 studies presented moderate methodologic consistency. In these studies, chlorhexidine (CHX) was the most beneficial in monitoring dental plaque data, and 4 meta-analyses showed that essential oils (EO) also had substantial antiplaque activity. Conclusion • Descriptive and experimental studies have shown that CHX and EO have antiplaque activity that is useful in maintaining good oral hygiene.
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