Iranian Red Crescent Medical Journal
Volume:20 Issue: 6, Jun 2018

Context: Neck pain is a very common symptom. Several clinical trial studies were conducted to evaluate the effects of cupping therapy on neck pain. The objective of this study was to assess the evidence for the effectiveness of cupping therapy as an intervention to conservative management of neck pain.
Evidence Acquisition: We performed a systematic search in PubMed, Ovid, MEDLINE, CINAHL, EMBASE, Cochrane Library, web of science, and Iranian medical databases through March 2017 without time restrictions. All clinical trials done on non- specific neck pain, where at least one of the therapies assessed pertains to cupping therapy, were included the study. Outcomes were pain intensity (e.g., Visual Analogue Scale, VAS), disability (e.g., Neck Disability Index, NDI), quality of life on sp36 questionnaire, and other outcomes due to neck pain. A meta-analysis was performed to assess the effectiveness of cupping in managing neck pain.
Meta-analysis of 5 trials revealed significant differences in pain relief in favor of cupping therapy compared with the control group (VAS 100 cm, MD, -0.84 (-1.22, -0.46), I2 = 54.7%). Furthermore, meta-analysis of 6 studies revealed that cupping therapy was clinically superior to the control group in patients with neck pain (SMD = -0.60 (-0.86, -0.35), I2 = 16.4%). Assessment of quality of life using the SP36 questionnaire showed that cupping therapy increased the quality of life in patients with neck pain compared with the control group (SMD = -0.56 (-0.20, -0.92), I2 = 51.4%).
This study provides some evidence that cupping therapy may improve treatment of patients with neck pain.

Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent liver diseases worldwide. There are several common risk factors between NAFLD and coronary artery disease (CAD).
This study aims to evaluate the relation between prevalence of NAFLD with severity of CAD in patients undergoing coronary artery angiography.
This study was a cross-sectional descriptive-analysis research that included 514 patients who underwent angiography. The severity of CAD was assessed by the number of vessels involved (vessel score: vd). An ultrasound was performed for all patients and intensity of fatty liver involvement was graded from 0 (absence of steatosis) to 3 (severe steatosis).
Ultrasonographic examination proven NAFLD in 59.1% of patients with different grades. Patients with NAFLD had significantly higher body mass index (P This study showed a high prevalence of NAFLD in patients with documented CAD. It is extremely important since knowing risk factors, designing screening programs, and early treatment of fatty liver could led to reducing the risk of cardiovascular diseases.

Although gestational diabetes may result in elevated leptin, osteocalcin, and TNF-α (Tumor necrosis factor) levels, impact of those parameters on neonatal outcome is not well established.
The aim of the current study was to evaluate whether cord blood leptin, TNF α, and osteocalcine have a predictive value for neonatal complications due to maternal GDM.
This cohort study was performed at Near East East University hospital, Nicosia, Cyprus. All pregnant females under follow-up of the department of gynocology and obstrectrics between years 2010 and 2012 were invited to participate. Those, who gave consent, were enrolled. Expecting mothers were categorized as GDM and normal pregnancy. Forty-one (21.5%) of the pregnancies were GDM and 159 (78.5%) were normal. Cord blood samples were obtained at delivery. Osteocalcin, leptin, and TNF-α levels and neonatal complications were evaluated thereafter.
Comparasion of pregnancy complications between groups revealed no significant differences except for more frequent maternal hypothyroidism in the GDM group (P 0.05). Newborns with hypoglycemia showed higher cord blood osteocalcine, TNF-α, and leptin. In addition, osteocalcin levels were significantly higher in cord blood of LGA babies born from GDM mothers (50.41 ± 32.79 and 35.19 ± 20.18 ng/mL).
In this study, cord blood leptin, osteocalcine, and TNF-α were significantly correlated with neonatal hypoglycemia. Moreover, cord blood osteocalcin levels were significantly higher in the GDM group. This increase in osteocalcin in the GDM group, may be related to the regulation of blood glucose levels by osteocalcin.

Osteoarthritis (OA) is a highly prevalent chronic degenerative joint disease with different risk factors, which need to be investigated in order to perform more appropriate interventions in earlier phases of OA. Therefore, the aim of this study was to determine the correlation between hip morphology and hip OA.
This cross-sectional study was conducted on patients aged 15 to 60 years old with hip problems, diagnosed with hip OA, compared with healthy individuals as the control group. Then radiographic parameters, such as alpha angle, acetabular angle of sharp (AA), lateral center-edge angle (LCEA), femoral neck shaft angle (FNA), coxa profunda, acetabular protrusio, cross over sign, posterior wall sign, and the ischial sign were measured by pelvic (AP) X-ray, using PACS systems in both groups.
This study found that alpha angle and AA were significantly greater in OA patients as compared to healthy individuals (P 0.05). By grouping studied angles, it was found that the frequency of alpha angle > 55°, AA > 38°, and LCEA > 40° were significantly higher in the OA group as compared to the control group (P The current results showed that higher Body Mass Index (BMI), greater alpha angle, AA and LCEA, and higher rate of posterior wall sign and acetabular protrusio increased the risk of OA, which support that these structural changes are major contributors to OA development.

Helicobacter pylori (H. pylori) plays the main role in increasing oxidative stress and causing stomach inflammation, peptic ulcers, and gastric malignancy in the infected patients. L-arginine (Arg) has antibacterial and anti-inflammatory effects.
The current study aimed at investigating the beneficial effects of L-arginine on inflammation and oxidative stress in patients infected with H. Pylori with dyspeptic symptoms.
The current randomized, double-blind controlled, clinical trial was conducted on 34 patients with H. pylori infection referred to the center of digestive disorders affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, in order to undergo endoscopy from December 2016 to September 2017. Patients were classified into 2 groups (control and treatment); the control group only received triple-drug therapy (including amoxicillin, clarithromycin, and omeprazole), and the treatment group received standard triple-drug therapy and L-arginine capsules for 3 weeks. Gastric biopsies and serum samples were taken from all patients before and after the study. Helicobacterpylori infection was examined by a rapid urease test and antioxidant indices including superoxide dismutase (SOD), glutathione peroxidase (GPX), and total antioxidant capacity (TAC) were evaluated in gastric biopsies. In addition, serum samples were used to measure the inflammation factors including interleukin (IL)-8 and tumor necrosis factor (TNF)-α.
Level of SOD activity increased significantly in the treatment group compared with that of the control group (4.91 ± 95.21 vs. 4.0 ± 44.11 IU/mg) (P = 0.001). In the treatment group, compared with the control group, the level of TAC increased significantly (0.35 ± 0.60 vs. 0.30 ± 0.9 mM/L) (P = 0.006) and the level of GPX activity increased significantly in the treatment group compared with the control group (10.68 ± 2.39 vs. 5.16 ± 2.12 IU/mg) (P = 0.000). Regarding the inflammation factor, IL-8 decreased significantly in the treatment group compared with the control group (8.00 ± 1.94 vs. 10.28 ± 2.10 pg/mL) (P = 0.002); also TNF-α decreased significantly in the treatment group compared with the control group (9.71 ± 2.69 vs. 12.24 ± 3.29 pg/mL) (P = 0.036), while there was no significant difference in high sensitivity C-reactive protein (hs-CRP) decrease between the treatment and the control groups (2.34 ± 1.28 vs. 3.04 ± 1.58 mg/L) (P = 0.16).
Consumption of L-arginine increased antioxidant indices and decreased inflammation in patients infected with H.pylori.

Despite a number of studies on the effects of complementary medicine products, the effects of caper fruit pickle (CFP), as an Iranian traditional medicine (ITM), is not clear in non-alcoholic fatty liver disease (NAFLD).
The current study aimed at assessing the effect of the CFP on anthropometric measures and some atherogenic indices in patients with NAFLD.
A 12-week randomized, controlled, double-blind trial was conducted on 44 patients with NAFLD via block randomization method assigned to either the control (n = 22) or the CFP (n = 22) groups, from March to October 2016 in Zanjan city, Iran. The CFP group received 40 - 50 g of the CFP with daily meals. Before and after the treatment, anthropometric measures, serum lipoprotein ratios and liver enzymes were assessed.
After 12 weeks, weight and waist circumference significantly decreased both in the CFP (P The current study results suggested that daily consumption of the CFP for 12 weeks may potentially prevent cardiovascular complications in patients with NAFLD. Further studies are needed to confirm the findings.

Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain due to arthralgia in the joint between the patella and femur. Many factors, including improper biomechanics and skeletal disorders, are associated with PFPS. The role of vitamin D deficiency in the pathogenesis of patellar chondromalacia has been known for several years.
The aim of the present study was to determine the prevalence of vitamin D deficiency in young people with PFPS and compare this with the prevalence in a healthy matched control group and to determine the correlation between occurrence of biomechanical abnormalities and serum levels of 25(OH)D in patients with PFPS.
In this case-control study, 40 patients aged 15 to 40 years old with a diagnosis of PFPS, that had referred to the rehabilitation clinic of a university hospital in Tabriz, Iran, were selected as the case group and 40 normal subjects of the same age range were selected as the controls. Serum 25(OH)D levels were assessed and a postural examination was performed on both groups, while severity of knee pain, plain knee radiographs, and serum levels of calcium and phosphorous were assessed only in PFPS patients.
Among the 80 participants, vitamin D deficiency (cutoff level of 25(OH)D ≤ 20 ng/mL) was observed in 55 participants (68.75%), including 35 (87.5%) patients and 20 (50%) controls, with a statistically significant difference (P Severe and moderate vitamin D deficiencies were more prevalent in young adults with PFPS than in normal adults. Knee pain severity and joint deformities were correlated with low levels of vitamin D in the case group. Therefore, attention to diet, vitamin supplementations, and biomechanical correction are the mainstay treatment of PFPS.

Captopril, a short-acting antihypertensive agent, is widely used in case of emergency to control blood pressure. Although sublingual captopril has a faster onset of action, it is less tolerated. This study was performed to evaluate the efficacy, side effects, and tolerability of sublingual versus oral captopril in an emergency setting.
Hypertensive patients, without acute target organ damage were randomly administered 25 mg captopril sublingually or orally (35 patients in each group). Blood pressure was measured at 0, 10, 20, 30, 45, 60, and 120 minutes after the administration. Patient satisfaction was subjectively scored on a scale of 1 - 10, and any side effect was recorded (Iranian registered clinical trials # IRCT2015110924963N1).
The mean age of the study groups was 59.61 ± 9.34 years. Systolic and mean blood pressure significantly decreased after 10, 20, and 30 minutes of sublingual administration (P In our study, the systolic and mean blood pressure decreased more rapidly in the sublingual captopril group than in the oral captopril group in the first 30 minutes after administration. Patients better tolerated the oral preparation, and the difference in the blood pressure reducing effect between the groups almost equalized after 90 minutes.

Varicocele is the leading cause of male infertility throughout the world.
This study aimed to identify the effects of varicocele on oxidative stress, total antioxidant capacity (TAC), and semen parameters.
In this cross sectional study, serum and semen samples were collected from nonvaricocele subjects (n, 35) and patients with varicocele (n, 86), who were referred to infertility and in vitro fertilization (IVF) centers of Babol Clinic Hospital, Babol, Mazandaran Province, Iran during 2015 - 2016. The semen samples were analyzed according to the world health organization (WHO) guidelines. After ultrasound and physical examinations, varicocele was classified into 3 grades: G1, G2, and G3. TAC and malondialdehyde (MDA) levels were measured in the serum and seminal plasma of subjects, using ferric reducing ability of plasma (FRAP) and thiobarbituric acid reaction (TBAR) methods, respectively. Nitric oxide (NO) was also measured using an NO assay kit.
The mean total sperm count in the G1, G2, and G3 groups was significantly lower than that of nonvaricocele men (P = 0.037; P = 0.003, and P = 0.044, respectively). A trend of lower semen volume was observed in the G3 group, compared with the nonvaricocele group (P = 0.06). A significant positive correlation was observed between elevated serum MDA level and varicocele degree (P G2 > G1 > nonvaricocele. There was also a significant negative correlation between the serum and seminal plasma TAC levels (P The reduced level of seminal plasma antioxidants, which is associated with increased lipid peroxidation, is one of the main reasons for low sperm quality in patients with varicocele. Antioxidant therapy may be useful in decreasing oxidative stress intensity and improving the condition of varicocele patients.