The impact of walnut leaf on the lipid and glucose profiles in diabetic patients: A systematic review and meta-analysis

Managing risk factors associated with cardiovascular diseases, such as blood lipids and blood sugar in people with diabetes (PWDs), is important. Besides antidiabetic medicines, herbal remedies such as walnut leaves have long been utilized to decrease blood sugar and blood lipid levels in PWDs. Hence, this study aimed to investigate the impact of walnut leaf on the lipid and glucose profiles of PWDs through a systematic review and meta-analysis. To gain access to the primary empirical studies, domestic and international databases were searched using MeSH keywords. The databases included Barakat Gostar, SID, Magiran, IranDoc, PubMed, Scopus, Web of Science, Embase, Cochrane, International Standard Randomized Controlled Trial Number (ISRCTN), International Clinical Trials Registry Platform (ICTRP), and Clinical Trial.gov (a clinical trial registration system). Data analysis was performed within Stata 14 software. The P-value was considered P <0.05. In 4 studies with a sample size of 101 individuals, which were published between 2014 and 2018, post-test scores of the treatment and control groups pointed out that the difference between insulin and FBS levels was statistically significant. The FBS level was higher in the control group than in the treatment group. However, their insulin level was lower than those in the treatment group. The difference between the levels of HbA1C, cholesterol, triglyceride, LDL, HDL, AST, ALT, ALP, and creatinine in the control and treatment groups was not statistically significant. The pre and post-test scores of the treatment group were compared. The levels of FBS, HbA1C, and LDL decreased significantly, while the patients' insulin levels increased remarkably. No noticeable correlation was observed in other lipid profiles. Due to the thoroughly limited research resources, further studies are required to confirm the findings more confidently

Efficacy and tolerability of fourteen-day sequential quadruple regimen

The optimal pharmacological regimen for eradication of Helicobacter pylori (H. pylori) has been investigated for many years. This study aimed to evaluate the efficacy and tolerability of bismuth-based quadruple therapy (B-QT) and a modified sequential therapy (ST) regimens in eradication of H. pylori. A randomized, double-blind trial was conducted on 344 patients. Patients with H. pylori infection and without a history of previous treatment were randomized to receive 14-day B-QT (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily) or 14-day ST (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and metronidazole 500 mg twice a day for seven days followed by bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and furazolidone 100 mg twice a day for additional seven days). Drug adverse effects were assessed during the study. H. pylori eradication was determined eight weeks after the end of treatment using 14C-urea breath test. Based on per-protocol and intention-to-treat, the eradication rate was significantly higher (p<0.05) in the B-QT regimen 91.9 % (95 % CI; 88.1-94.0) and 90.2 % (95 % CI; 86.3-92.9), respectively compared to the ST regimen 80.8 % (95 % CI; 76.6-84.9) and 78.1 % (95 % CI; 73.7-82.4), respectively. The severity of vomiting and loss of appetite were significantly higher in ST regimen (p<0.05). The B-QT regimen was more effective and safer than the ST regimen. Conclusively, it is suggested to assess the efficacy and safety of this regimen in longer studies, larger population, and in other communities

Acute pancreatitis in severe leptospirosis infection

(Received 18 May,2008 ; Accepted 10 Sep, 2008) Abstract Leptospirosis is a Zoonotic disease that rarely manifests in a severe manner, (Weil's syndrome). Regarding epidemiology of this disease, in some rural areas of Mazandaran Province we encountered a rare case of acute pancreatitis during progression of severe Leptosprosis is presented herein. Patient is a 50 year old male farmer who was admitted to the hospital due to experiencing 10 days of fever, myalgia, vomiting, jaundice and abdominal pain. He underwent haemo-dialysis due to acute renal failure only once. Direct bilirubin was 31.7 mg/dl with serum amylase, while lipase was three times more than normal levels. The CT-Scan demonstrated diffuse pancreatic enlargement. The IgM titer fourfold which was more than normal level against leptospirosis (ELISA) confirmed the diagnosis. Patient was cured completely through supportive care and antibiotic therapy, thus, this case was reported in drawing attention to Leptospira infections, which should be considered in the differential diagnosis of patients with jaundice and pancreatitis. J Mazand Univ Med Sci 2008; 18(66):92-97(Persian

Relationship between Using Detergents and the Risk of Ulcerative Colitis in Mazandaran, Iran 2014-17

Background and purpose: Inflammatory bowel disease (IBD) is a group of mucosal inflammatory problems affecting the small or large intestine. Since last century, the incidence of IBD has been constantly increasing, afflicting the majority of urban population in developed societies. The aim of this study was to investigate the relationship between using detergents and the risk of ulcerative colitis (UC). Materials and methods: In this case-control trial, 65 patients with new-onset UC and 135 healthy people were examined during 2014-17 in Sari Imam Khomeinin Hospital. Demographic features and information about exposure to detergents and bleaches were recorded using a researceher-made questionnaire. SPSS V20 was used to investigate the association between exposure to detergents and development of UC and the logistic regression model was used to adjust for potential confounding factors. Results: According to findings, gender (P= 0.012), age (P= 0.009), job (P<0.001), and using detergents (P<0.001) were associated with UC. Compared to those who were occasional consumers of detergents, the chances of UC, after adjustment for potential confounding factors such as gender, age, and job, were 4, 23, 26, and 104 times higher in patients who used detergents monthly, every other week, weekly, and daily, respectively. Conclusion: Frequent exposure to detergents can be among the factors influencing the development of UC

Pachydermoperiostosis in a Patient with Crohn’s Disease: Treatment and Literature Review

Pachydermoperiostosis (PDP) is a rare disorder characterized by pachydermia, digital clubbing, periostitis, and an excess of affected males. It is the primary form of hypertrophic osteoarthropathy (HOA) and there are some rare associations of PDP with other disorders. Here we describe a patient with Crohn’s disease associated with PDP. A 26-year-old man, who was a known case of Crohn’s disease, referred with diffuse swelling in the upper and lower limbs and cutis verticis gyrata since 7 years ago. PDP was suspected and endocrinological and radiological studies were conducted for the evaluation of underlying disease. He was prescribed celecoxib, low-dose prednisolone, and pamidronate to control the swelling, periostitis, azathiopurine, and mesalazine according to gastrointestinal involvement. In conclusion, it is important to identify this condition since a misdiagnosis might subject the patient to unnecessary investigations

The impact of walnut leaf on the lipid and glucose profiles in diabetic patients: A systematic review and meta-analysis

474-482Managing risk factors associated with cardiovascular diseases, such as blood lipids and blood sugar in people with diabetes (PWDs), is important. Besides antidiabetic medicines, herbal remedies such as walnut leaves have long been utilized to decrease blood sugar and blood lipid levels in PWDs. Hence, this study aimed to investigate the impact of walnut leaf on the lipid and glucose profiles of PWDs through a systematic review and meta-analysis. To gain access to the primary empirical studies, domestic and international databases were searched using MeSH keywords. The databases included Barakat Gostar, SID, Magiran, IranDoc, PubMed, Scopus, Web of Science, Embase, Cochrane, International Standard Randomized Controlled Trial Number (ISRCTN), International Clinical Trials Registry Platform (ICTRP), and Clinical Trial.gov (a clinical trial registration system). Data analysis was performed within Stata 14 software. The P-value was considered P <0.05. In 4 studies with a sample size of 101 individuals, which were published between 2014 and 2018, posttest scores of the treatment and control groups pointed out that the difference between insulin and FBS levels was statistically significant. The FBS level was higher in the control group than in the treatment group. However, their insulin level was lower than those in the treatment group. The difference between the levels of HbA1C, cholesterol, triglyceride, LDL, HDL, AST, ALT, ALP, and creatinine in the control and treatment groups was not statistically significant. The pre and post-test scores of the treatment group were compared. The levels of FBS, HbA1C, and LDL decreased significantly, while the patients' insulin levels increased remarkably. No noticeable correlation was observed in other lipid profiles. Due to the thoroughly limited research resources, further studies are required to confirm the findings more confidently

Efficacy of clarithromycin containing bismuth-based regimen as a second-line therapy in helicobacter pylori eradication

BACKGROUND The eradication of Helicobacter pylori infection, commonly prevailing in the stomach, has been important since its introduction. Adequate preparations should be made in finding alternatives when faced with first-line treatment failures. Currently, ideal second-line treatments are indistinct and varied among countries as result of different antibiotic resistance patterns. We aimed to evaluate the safety and efficacy of a clarithromycin-containing bismuth-based quadruple regimen as a second-line treatment. METHODS Forty-eight H.pylori-positive patients with proven gastric or duodenal ulcers and/or erosions who had previously failed to respond to furazolidone-containing regimens were enrolled. They received pantoprazole (40 mg-bid), amoxicillin (1gr-bid), bismuth subcitrate (240 mg-bid), and clarithromycin (500mg-bid) for 10 days. Eight weeks after treatment, a 14C-urea breath test was performed for the re-evaluation of H. pylori eradication. RESULTS Forty-three patients completed the study. H.pylori eradication rates were 79.2% (95% CI=65.00-89.53) and 88.4% (95% CI=74.91-96.11) according to intention-to-treat and per-protocol analyses, respectively. All patients had excellent compliance to treatment and one did not continue therapy because of adverse effects. CONCLUSION In developing countries such as Iran, a ten-day clarithromycin-containing bismuth-based quadruple regimen is encouraged as a second-line treatment because of the acceptable rate of eradication and low adverse effects

A comparison between standard triple therapy and sequential therapy on eradication of Helicobacter pylori in uremic patients: A randomized clinical trial

Background: The prevalence of peptic ulcer disease in hemodialysis dependent patients is higher than the general population. These patients are also more prone to upper gastrointestinal bleeding. The aim of this study was to compare the effects of a standard triple therapy with a sequential therapy on Helicobacter pylori eradication in azotemic and hemodialysis patients. Materials and Methods: Forty nine hemodialysis and azotemic patients, naïve to H. pylori treatment, were randomized into two groups to receive either standard triple therapy (pantoprazole 40 mg, amoxicillin 500 mg and clarithromycin 250 mg twice a day for 14 days) or a sequential therapy (pantoprazole 40 mg for 10 days, amoxicillin 500 mg twice a day for the first 5 days and clarithromycin 250 mg + tinidazole 500 mg twice a day just during the second 5 days). H. pylori eradication was evaluated by fecal H. pylori antigen assessment 8 weeks after the treatment. Results: Of 49 patients, 45 patients (21 in triple therapy group and 24 in the sequential group) completed the study. Based on intention to treat analysis, H. pylori eradication rates were 66.7% (95% confidence interval [CI]: 47.8-85.5%) in standard triple therapy group and 84% (95% CI: 69.6-98.3%) in sequential therapy group (P = 0.34). Per-protocol (PP) eradication rates were (95% CI: 76.2%. 6-89.3%) 54 and 87.5% (95% CI: 68.8-95.5%), respectively (P = 0.32). Conclusion: According to Maastricht III consensus report, the results of our study showed that sequential therapy might be a better choice compared with the standard triple therapy in azotemic and hemodialysis patients Iran. We propose to assess the effects of shorter-duration sequential therapy (less than 10 days) for H. pylori eradication