The effect of Salvia officinalis on blood glycemic indexes and blood lipid profile in diabetic patients: a systematic review and meta-analysis.

Diabetes is one of the most common endocrine disorders that increases the economic burden on the public health system. In this regard, understanding the effect of available herbs on diabetes can be useful. This systematic review was performed to determine the effect of Salvia officinalis on blood glycemic indexes and blood lipid profile (primary outcomes) and 2 h postprandial blood glucose (2HPPG), alanine transaminase (ALT) (U/L) and aspartate transaminase (AST) (U/L) and its side effects (secondary outcomes) in diabetic patients. A systematic search was conducted in the English (Cochrane Library, Medline (PubMed), Scopus, CINAHL, ProQuest and Persian databases since inception to March 2021, without publication time restriction. Two authors separately evaluated the quality of the articles using Cochrane Collaboration's tool for assessing the risk of bias in randomized trials and extracted the data. Heterogeneity of data was evaluated by squared I (I 2). Three studies included in the review and all of them included in meta-analysis. The results of meta-analysis showed that S. officinalis reduced fasting blood sugar (FBS) (mg/dL) (MD: -31.15; 95% CI: -37.56 to -24.73; p<0.00001). It also reduced HbA1c (%) (MD: -0.94; 95% CI: -1.25 to -0.63; p<0.00001) and total cholesterol (mg/dL) (MD: -43.64; 95% CI: -83.26 to -4.02; p=0.03) and reduction of low-density protein (LDL) (mg/dL) (MD: -19.23; 95% CI: -35.81 to -2.65; p=0.02) but it did not have a significant effect on triglyceride (mg/dL) (p=0.09), and high-density lipoprotein (HDL) (mg/dL) (p=0.18). Regarding the secondary outcomes, S. officinalis also had significant effect on 2HPPG, but it did not have a significant effect on ALT (U/L) and AST (U/L). No specific side effects for this plant were reported in these three studies. The results showed that S. officinalis has a positive effect on blood glycemic status and blood lipid profile in diabetes except for triglyceride and HDL. However, due to the small number of included articles, it is recommended that stronger clinical trials be conducted in this field.

A double-blind, randomized pilot study for comparison of Melissa officinalis L. and Lavandula angustifolia Mill. with Fluoxetine for the treatment of depression.

BACKGROUND: Depression has rapidly progressed worldwide, and the need for an efficient treatment with low side effect has risen. Melissa officinalis L and Lavandula angustifolia Mill have been traditionally used in Asia for the treatment of depression. Many textbooks of traditional Persian medicine refer to these herbs for the treatment of depression while there are no adequate clinical trials to support this claim. The present study aimed to evaluate the efficacy of M. officinalis and L. angustifolia compared to fluoxetine for the treatment of mild to moderate depression in an 8-week randomized, double-blind clinical trial. METHODS: Forty-five adult outpatients who met the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) for major depression, were randomly assigned to 3 groups to daily receive either M. officinalis (2 g) or L. angustifolia (2 g) or fluoxetine (20 mg) and were assessed in weeks 0, 2, 4 and 8 by the Hamilton Rating Scale for Depression (HAM-D) including 17 items. RESULTS: Our study showed that M. officinalis and L. angustifolia effect similar to fluoxetine in mild to moderate depression. (F = 0.131, df = 2,42, p = 0.877). CONCLUSION: Due to some restrictions in this study including absence of placebo group, large-scale trials are needed to investigate the anti-depressant effect of these two herbs with more details. TRIAL REGISTRATION: IRCT2014061718126N1 . Registration date: 2015-06-04-"Retrospectively registered".

Avicenna (980-1037 CE) and his Early Description and Classification of Dementia.

According to the World Health Organization (WHO), dementia is a disorder that occurs as result of a neurodegenerative process in brain, and usually is chronic or progressive by nature. Most descriptions of senile dementia date back to Alois Alzheimer. In 1906, Alzheimer described the first patient, Auguste Deter, who suffered from the disorder that later became known as Alzheimer's disease. Although, the history of the disease before 1906 is quite rich, little has been said about the contributions of ancient and medieval physicians to the understanding of dementia. Over the centuries, the concept of senile dementia changed from an inevitable mental decline with aging, to different sets of clinical features with narrow limits of diagnosis of a disease in its own right. Documentation of the historical origins of prevention, diagnosis, and therapies of dementia would make an important contribution to a more complete understanding of this pathological degeneration of dementia. The present review focuses on the contributions of Avicenna (AD 980-1037) to the development of diagnosis and the discovery of etiology of different forms of dementia, with the goal of revealing the extent to which dementia was understood in the golden age of Islam in Persia.

Association between core body temperature and mean airway pressure with endotracheal cuff pressure in intubated patients of emergency department.

BACKGROUND & OBJECTIVE: Endotracheal intubation is routinely performed in the critical situations. In order to prevent microaspiration and tracheal injury endotracheal cuff pressure is important to remain constant between 20 and 30 cmH2O. Positive pressure ventilation, duration of intubation, body temperature, and body movements can alter endotracheal cuff pressure. This survey was conducted to evaluate core body temperature and cuff pressure relation with airway pressure simultaneously. METHODS: This was a descriptive analytic study conducted from March 2018 to July 2018 on 150 intubated patients in the emergency department. All were ventilated with SIMV mode and had Ramsi sedation level of 2-3. Mean airway pressure was measured simultaneouly with core body temperature measurement from ventilator monitor. All these parameters were measured 10 times each hour and documented. RESULTS: There was a statistically meaningful relation between airway pressure and cuff pressure in the primary evaluation (P=0.02, r=0.19), while none of the subsequent evaluations showed meaningful relation (P>0.05). No significant relation was found between cuff pressure and core body temperature in any of the measurements (P>0.05). CONCLUSION: The pressure of cuff should be checked repeatedly after intubation because of substantial variation over time. Factors other than core body temperature and airway pressure can influence cuff pressure.

First Report of a Disease by Rhazes 10 Centuries Ago.

INTRODUCTION: Abu Bakr Mohammad Ibn Zakariya Al-Razi (865-925 CE), who was known as "Rhazes" in the west, was a famous scientist of medieval ages. He has more than 200 books and treatises. His masterpiece on medicine "Kitab Al-Hawi Fi Al-Tibb" contains around 900 case reports. Some of the diseases which seem to be recently reported have been stated previously, but not well described. Considering symptoms of the patient described at that time, differential diagnosis will be discussed. CASE PRESENTATION: Rhazes described a patient with bilious fever. He had developed bloody urine and stool on the fourth day and fatigue. Subsequently, the patient's urine and stool color turned into dark and black, respectively, and died the following day. According to Rhazes attitude, it was malignant measles. Meyerhof in his book has referred to post-measles acute glomerulonephritis, but more appropriate differential diagnoses are compatible with this patient. DISCUSSION: One of the best diagnoses for this case can be Weil's syndrome. Presence of fever, icterus, hemorrhage and renal injury, all suggest Weil's syndrome without pulmonary involvement. The other probable diagnosis is thrombotic thrombocytopenic purpura (TTP). Meningococcal sepsis is the other possible diagnosis. CONCLUSION: To sum up, as three compatible diseases with the case; have been described more than a thousand years after Rhazes (Weil's syndrome 1886, TTP 1925 and meningococcemia 1805); if the case is either Weil's or TTP or meningococcal sepsis, it is the first report of the disease in the world by Rhazes.

Accuracy of Neck stiffness, Kernig, Brudzinski, and Jolt Accentuation of Headache Signs in Early Detection of Meningitis.

INTRODUCTION: The diagnostic value of clinical signs in early diagnosis of meningitis has been evaluated but the existing results are contradicting. The present study aimed to evaluate the accuracy of Kernig, Brudzinski, neck stiffness, and Jolt Accentuation of Headache (JAH) signs in this regard. METHODS: In this diagnostic accuracy study, patients with suspected meningitis who were referred to the emergency department were examined regarding presence or absence of the mentioned clinical signs and screening performance characteristics of the signs were calculated. Cerebrospinal fluid analysis was used as the reference test. RESULTS: 120 cases with mean age of 48.79 ± 21.68 years (18 - 93) were studied (63.3% male). Diagnosis of meningitis was confirmed for 45 (37.5%) cases. Neck stiffness (p < 0.001), Kernig (p < 0.001), Brudzinski (p < 0.001), and JAH (p < 0.001) had significantly higher frequency among patients with meningitis. The accuracy of neck stiffness, Kernig, Brudzinski, and JAH signs in early detection of meningitis were 0.676 (95% CI: 0.575-0.776), 0.667 (95% CI: 0.552-0.782), 0.720 (95% CI: 0.619-0.821), 0.749 (95% CI: 0.659-839), respectively. CONCLUSIONS: It seems that diagnostic value of JAH is higher than other clinical signs but the accuracy of all signs is in poor to fair range. JAH had the highest sensitivity and Kernig and Brudzinski had the highest specificity.

The PCQP Score for Volume Status of Acutely Ill Patients: Integrating Vascular Pedicle Width, Caval Index, Respiratory Variability of the QRS Complex and R Wave Amplitude.

INTRODUCTION: Techniques for measuring volume status of critically ill patients include invasive, less invasive, or noninvasive ones. The present study aims to assess the accuracy of noninvasive techniques for measuring volume status of critically ill patients. PATIENTS AND METHODS: A total of 111 critically ill patients admitted to the emergency department and undergoing central venous catheterization were included in the study. Five parameters were measured including vascular pedicle width (VPW), diameter of inferior vena cava, caval index, respiratory changes in QRS, and P wave amplitude. Patients with risk factors which could decrease the accuracy of central venous pressure (CVP) value were excluded from study. We compared these parameters with static CVP parameter. Finally, based on the afore-mentioned parameters, PCQP role in criteria was designed. RESULTS: In detecting loss of circulating blood volume, area under the curve of VPW was 0.92 (90%, confidence interval [CI]: 0.85-0.99), diameter of inferior vena cava was 0.82 (90%, CI: 0.72-0.91), caval index was 0.9 (90%, CI: 0.82-0.98), and changes in QRS and P waves were 0.88 (95%, CI: 0.81-0.95) and 0.73 (95%, CI: 0.63-0.82), respectively. PCQP role in criteria was designed according to these parameters, and at its best cutoff point (score 6), VPW had a sensitivity of 97.4% (95%, CI: 84.57-99.99) and specificity of 83.6% (95%, CI: 72.65-90.86) for the detection of loss of circulating blood volume (<8 cmH2O). CONCLUSION: PCQP score could be a reliable and noninvasive technique for the assessment of volume status in critically ill patients.

Diagnostic Value of Sonography for Confirmation of Endotracheal Intubation in the Emergency Department.

BACKGROUND: Intubation and maintaining airway are crucial in the management of critically ill patients in the emergency department. Correct tracheal intubation should be confirmed by the physician, otherwise oesophageal intubation could lead to hypoxia with detrimental consequences and even death. Sonography can be used to determine proper placement of the tracheal tube. METHODS: In this study, 75 patients, with an indication of intubation and age older than 18 years entered the study. An emergency medicine performed real-time sonography of the trachea to evaluate the correct placement of endotracheal tube. Tube passage (snowstorm) and vocal cord angel widening (bullet sign) were evaluated, and then both lungs sliding and diaphragm movement were evaluated to confirm correct tube placement and ventilation. RESULTS: In this study, 75 patients entered the study. The mean age of the patients was 61.12; 47 patients (62.7%) were male and 28 (37.3%) were female. The reason of intubation was the decreased level of consciousness in 22 cases (29.3%), cardiopulmonary arrest in 22 patients (29.3%), respiratory distress in 9 patients (12%), shock in 10 patients (13.3%), and seizure in 1 case. Snowstorm sign was seen in 72 patients (96%). Bullet sign was objected in 24 cases (32%). Lung sliding was seen bilaterally in 63 patients (84%) and unilaterally in 7 patients (9.3 %), but it was not noticed in 6.7% of the patients (5 patients). CONCLUSIONS: Transverse tracheal and lung sonography in the emergency department can be a fast measure to confirm correct endotracheal intubation.