A randomized, double blinded, placebo-controlled clinical trial of silymarin in ulcerative colitis / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of silymarin in ulcerative colitis (UC) patients.</p><p><b>METHODS</b>A randomized double blinded placebo-controlled clinical trial was conducted in 80 UC patients whose disease had been documented and were in remission state between September 2009 and October 2010. Patients were assigned to silymarin group (42 cases) and placebo group (38 cases) using a random number table. Either silymarin (140 mg) or placebo (lactose mono-hydrate, corn starch magnesium stearate) tablets were given once daily for 6 months along with their standard therapy. The efficacies were assessed by disease activity index (DAI), frequency difference of the disease flare-up, and paraclinical data.</p><p><b>RESULTS</b>Ten patients (4 in the silymarin group due to nausea and 6 in the placebo group due to disease flare-up and abdominal pain) discontinued the study. An improvement in hemoglobin level (11.8±1.6 g/dL vs. 13.4±1.2 g/dL,P<0.05) and erythrocyte sedimentation rate (23.7±11.5 mm/h vs.10.8±3.2 mm/h,P<0.05) was observed in the silymarin group but not in the placebo group. DAI significantly decreased in the silymarin group and reached from 11.3±3.5 to 10.7±2.8 (P<0.05). Thirty-five out of 38 patients in the silymarin group were in complete remission with no flare-up after 6 months as compared to 21 out of 32 patients in the placebo group (P=0.5000).</p><p><b>CONCLUSION</b>Silymarin as a natural supplement may be used in UC patients to maintain remission.</p>

Antioxidants and infertility treatment, the role of Satureja Khuzestanica: a mini-systematic review

The use of antioxidants in the treatment of infertility has been suggested and recent studies have indicated that oral administration of Satureja Khuzestanica essential oil [SKEO] to rats induces significant antioxidative effects. This systematic review was conducted to evaluate the effectiveness of antioxidants in infertility and also to assess the effectiveness of Satureja Khuzestanica in infertility management. Pubmed, Scopus, and Cochrane Library were searched for relevant trials published from respective database inception dates to August 2010. Study selection, and data extraction were performed by authors. Fifteen trials on evaluation of antioxidants in infertility and seven studies on the effectiveness of Satureja Khuzestanica were identified. Only 4 of the 15 trials were with application of allocation concealment and three studies were done in in-vitro environment. Despite the methodological and clinical heterogeneity of the trials, 14 of the 15 [93.33%] trials showed an improvement in either sperm quality or pregnancy rate after antioxidant therapy. The human and animal studies of Satureja Khuzestanica showed a significant antioxidative potential of the plant and its effectiveness for infertility improvement. The use of oral antioxidants in infertility could improve sperm quality and pregnancy rates. Improved fertility observed by SKEO in rats might be due to its antioxidative effect. Further studies and clinical trials in humans are necessary to evaluate SKEO effectiveness in fertility disturbances

Management of community acquired pneumonia in a teaching hospital: the role of established guidelines

In spite of established guidelines developed by the American Thoracic Society [ATS], Infectious Disease Society of America [IDSA] and Centers for Disease Control [CDC], there is no consensus among physicians regarding hospitalization and choice of antibiotics for management of community-acquired pneumonia [CAP]. This study was conducted to determine the percentage of patients appropriately assessed for admittance and the antibiotic treatment selections that were in accordance with the established guideline criteria. This retrospective chart review study was conducted at the National Research Institute of Tuberculosis and Lung Disease [NRITLD], Masih Daneshvari Hospital during 2005-2006. Patients with a definite diagnosis of CAP were selected and entered the study. The previous IDSA, ATS and CDC guidelines and the more recent IDSA/ATS CAP guidelines were all used to evaluate the management of patients admitted with CAP. Patients were excluded if information was not sufficient. A total of 31 patients were reviewed. Of the 31 patients included in the study, 24 [77%] could have been treated with outpatient regimens. Six of 31 cases [19%] had been treated with regimens consistent with all three [IDSA, ATS, and CDC] guidelines. Twelve of 31 cases [39%] had corresponded to the previous treatment recommendations from ATS. The management of the remaining 13 patients [42%] had not corresponded to any of the mentioned guidelines. When compared to the recently published joint guidelines of ATS/IDSA, 12 of 31 cases [39%] had appropriately corresponded to the treatment recommendations. According to this study only one fifth of the cases reviewed could have been treated on an inpatient basis. Considering the standard guidelines 42% of the patients did not follow the recommendations from evidence-based guidelines. The enforcement of guideline usage through education and surveillance in university hospital settings may be required. We suggest the use of evidence-based medicine in the treatment of CAP